Children's Wellbeing and Schools Bill (Fifth sitting)
Tuesday 28th January 2025
(2 days, 18 hours ago)
Public Bill CommitteesRead Full debate Children’s Wellbeing and Schools Bill 2024-26 View all Children’s Wellbeing and Schools Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 January 2025 - (28 Jan 2025)
The Committee divided: - Ayes: 5 / Noes: 11 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 11 - Question accordingly negatived.
Neil O'Brien (Harborough, Oadby and Wigston) (Con)
I beg to move amendment 23, in clause 7, page 12, line 13, at end insert —
“(3A) Where staying close support is provided, it must be provided with due regard to the wishes of the relevant person and a record must be kept of that person’s wishes.”
This amendment would require local authorities to take account of the wishes of the relevant young person when providing staying close support, and keep a record of those wishes.
The Chair
With this it will be convenient to discuss the following:
Amendment 40, in clause 7, page 12, line 22, at end insert—
“(vi) financial support;
(vii) financial literacy”
Amendment 41, in clause 7, page 12, line 28, at end insert—
“(c) the provision of supported lodgings, where the young person and local authority deem appropriate.”
Clause stand part.
Neil O'Brien
It is a pleasure to serve under your chairmanship, Mr Stringer. As we return to our work on the Bill with clause 7, I want to say that it is still a bit disappointing that we have been through Second Reading, and here we are on the third day of Committee, and we still do not have the impact assessment for the Bill, which could potentially answer some of the questions that we will be raising today. I know the Ministers want to do the right thing in trying to get it out of the relevant committee and published, and I hope they can succeed in doing that pretty soon.
On clause 7, no reasonable person would argue that a young person leaving care does not require some support to live independently. Young people who have not been in care often require years of support to live independently, and they are less likely to be doing so away from home and will be in less difficult circumstances. Again, the Opposition support the Government’s objectives in this clause to provide staying close support, but we have some questions about how it is to work in practice.
First, the Bill gives discretion to the local authority on whether this support is in the best interests of a young person’s welfare. Surely the assumption should be that the support is offered, and it should be the exception to withhold it. One advantage in having the onus turned round would be that the local authority would have to record and explain decisions not to offer that kind of support. What sort of criteria are the local authorities supposed to use to make those choices, and will that be consistent across the country?
Secondly, there is also a question about the process for identifying the person who is to help the young person. The Department’s policy summary quite rightly talks about identifying a “trusted person”, which is obviously very important to this kind of young person. By definition, some young people in care have pretty good reasons not to trust adults around them, so how are local authorities to go about identifying such a “trusted person”? Thirdly, and this is a small point, will there be digital options to support young people? These days, that is clearly the most frequent method that young people use to get information, particularly sensitive information. It gives young people a choice of how they find their information, and there is potentially an opportunity for some good practice here in setting up a good way of communicating with their trusted person.
That leads me to a wider point. As we have gone through this Bill, and we will continue to make this point, there is a risk that local authorities, when confronted with these new duties, will obey the letter of the law, but will they really fulfil the spirit and good intent of Ministers in passing the Bill? Can the Minister be clear that this is not supposed to be just another signposting service? As young people leave care, they need personal advocates who can help them articulate their needs with other agencies, not a phone number or email address to contact. They do not really need more leaflets; they need a human being who can be trustworthy and provide practical help and advice. Signposting can quickly turn into a doom-loop dead end and no help. How does the Minister also envisage the involvement of local charities, some of whom will have had quite long-term links with the young person in care, and how will that be funded?
I will come on to this point on other amendment, but I ask here what the Minister makes of the call from the Our Wellbeing, Our Voice coalition for a national wellbeing measurement of care leavers. That would obviously support some of those points.
Does the Government plan to accept the recommendation of the Family Rights Group to offer lifelong links to all care leavers to help them have better relationships with those that they care about? Again, is there an opportunity here? Many constituency MPs will know people who have been in care and then become carers. There is this cycle—I know several people like this, and I will talk about one of them later on today. If we are getting into the business of continuing relationships after leaving care, which is a good thing, I wonder whether that can become something bigger—a lifelong connection, for those who want it, obviously, as a way of getting much-needed carers to stay in the system.
There is a risk that these measures are all very local authority-focused rather than focused on the needs of the young person. Amendment 23 would ensure that the voice of the child is heard and that we have the information that we need to allow for continuous improvement. It is very light touch. Keeping a record of the person’s wishes would help to protect against the loss of knowledge when personnel change. If things are written down, it is easier for a new person to come in and pick up and understand a bit about what that young person has said they want. In the longer term, it also provides a resource for learning and performance improvement. I talked in the previous session about kaizen and continuous improvement. The amendment is designed to support that, to improve continuity and to make sure that the voice of the young people for whom this very sensible form of care is to be provided is heard.
Darren Paffey (Southampton Itchen) (Lab)
It is a pleasure to serve under your chairmanship, Mr Stringer. I rise to support clause 8 stand part. [Interruption.] Sorry, my mistake.
Ian Sollom (St Neots and Mid Cambridgeshire) (LD)
It is a pleasure to serve under your chairmanship, Mr Stringer. The Liberal Democrats welcome the new requirements on local authorities in the clause to assess whether certain care leavers aged under 25 require the provision of staying close support. The charity Become, which supports care-experienced children, has found that care-experienced young people are nine times more likely to experience homelessness than other young people and that homelessness rates for care leavers have increased by 54% in the last five years. This is a really important clause.
Amendment 40 deals with the definition of staying close support. It uses the existing definition of the services, which should be set out in the local offer from local authorities. Become’s care advice line has found that care leavers are often unaware of the financial support available from the local authority, such as council tax discounts, higher education bursaries and other benefits. That can lead them to face unnecessary financial hardship. That is the reason for the financial support part of the amendment.
More generally, financial literacy can have a huge negative impact on care leavers, who are more likely to live independently from an earlier age than their peers—they are not necessarily living with parents or guardians. We would really like to see local authorities lay out that financial literacy support to help them understand what is available to them.
Amendment 41 would add information about supported lodgings to the list of available support services. Supported lodgings are a family-based provision within a broader category of supported accommodation. A young person aged 16 to 23 lives in a room within their supporting lodgings, which are the home of a host, who is tasked with supporting the young person as they go towards adulthood and independence, giving them practical help and teaching them important life skills such as financial literacy, budgeting and cooking. Requiring local authorities to signpost care leavers to any of the supported lodging provisions in their area could make a real difference to those young people and their lives, so I would really appreciate support for the amendment.
The Minister for School Standards (Catherine McKinnell)
I will speak to amendments 23, 40 and 41 and to clause 7.
Amendment 23 was tabled by the hon. Members for Harborough, Oadby and Wigston and for Central Suffolk and North Ipswich, and I thank them for it. The amendment draws attention to an important principle that must run through the whole approach that local authorities take to listening and responding to the wishes and feelings of their care leavers. When a local authority is assessing what staying close support should be provided to a young person, it should have regard to their wishes, which is why we intend to publish statutory guidance that will draw on established good practice that we want all local authorities to consider. It will cover how that will work, with interconnecting duties, especially the duty to prepare a pathway plan and keep it under a review. In developing and maintaining the plan and support arrangements, there is a requirement for the care leaver’s wishes to be considered.
In response to the specific questions raised by the hon. Member for Harborough, Oadby and Wigston, as I said, pathway planning is already a statutory requirement to eligible care leavers, so the statutory guidance will set out how and when care leavers should be assessed based on their own needs and using the current duties to support care leavers with reference to a trusted individual. Those individuals will often already be known to the young person, such as a former children’s home staff member, and that will clearly be set out in the statutory guidance. We will base that on the best practice that we see already in train.
On the lifelong links, we are currently funding 50 family finding, befriending and mentoring programmes, which are being delivered by 45 local authorities. The programmes will help children in care and care leavers to identify and connect with important people in their lives, improving their sense of identity and community and creating and sustaining consistent, stable and loving relationships. I recognise the points that the hon. Gentleman made. The Department for Education has commissioned an independent evaluation of the family finding, befriending and mentoring programme, which will inform decisions about the future of the programme and how it will work.
On amendment 40, each care leaver will have their own levels of need and support. Local authorities have a duty to assess the needs of certain care leavers and prepare, create and maintain a pathway for and with them. Statutory guidance already makes it clear that the pathway planning process must address a young person’s financial needs and independent living skills. Where eligible, they will be able to have access to financial support and benefits as well as support to manage those benefits and allowances themselves. That will be strengthened by the support made available through clause 7, including advice, information and representation, to find and keep suitable accommodation, given that budgeting and financial management issues can be a significant barrier to maintaining tenancies for many care leavers. That will include advice and guidance to local authorities to aid in the set-up and delivery, building on best practice of how current grant-funded local authorities are already offering support to access financial services and financial literacy skills for their care leavers.
To respond to amendment 41, we know that some care leavers may not feel ready to live independently straight away; that is where supported lodgings can offer an important suitable alternative. They are an excellent way for individuals with appropriate training to offer a room to a young person leaving care and a way for that young person to get the practical and emotional support to help them to develop the skills they need for independent living. We will continue to encourage the use of supported lodgings for care leavers where it is in the best interests of the young person.
However, we do not feel that amendment 41 is needed. Clause 7(4)(a) specifies that staying close support includes help for eligible care leavers
“to find and keep suitable accommodation”.
That will include support to find and keep supported lodgings where the young person and the local authority consider it appropriate. We will make that and other suitable options absolutely clear in statutory guidance, building on the best practice from the current staying close programme.
Munira Wilson (Twickenham) (LD)
It is good to hear that supported lodgings will be referred to in statutory guidance. I heard from the charity Home for Good, which is involved in setting up those networks of local authorities that provide supported lodgings, that in some local authorities money for supported lodgings cannot be found, because the local authority thinks that fostering money cannot be used for supported lodging and that it cannot use staying close support. Real clarity that staying close support funding can be used for supported lodgings is important to make this option work.
Catherine McKinnell
I appreciate the hon. Lady’s interest in this matter. We will produce the statutory guidance to make all this absolutely clear.
Before I come to clause 7 stand part, I want to respond to an additional question from the hon. Member for Harborough, Oadby and Wigston that I did not answer earlier. He asked about digital options and, as someone standing here using an iPad, I recognise the importance of that, particularly for young people. The local authorities already work with a range of digital options to connect with their care leavers, and we would certainly expect that to continue, and expect good practice to continue being developed and to be set out in the statutory guidance.
Turning to clause stand part, clause 7 requires each local authority to consider whether the welfare of former relevant children up to the age of 25 requires staying close support. Where this support is identified as being required, the authority must provide staying close support of whatever kind the authority considers appropriate, having regard to the extent to which that person’s welfare requires it.
Staying close support is to be provided for the purpose of helping the young person to find and keep suitable accommodation and to access services relating to health and wellbeing, relationships, education and training, employment and participating in society. This support can take the form of the provision of advice, information and representation, and aims to help to build the confidence and skills that care leavers need to be able to live independently.
The new duties placed on local authorities by this clause will not operate in isolation. They will be part of the existing legislative framework, which sets out the duties that every local authority already owes to its former children in care aged 18 to 25. This clause enhances and expands the arrangements for those children by supporting them to find long-term stable accommodation and access to essential wraparound services. The new statutory guidance will set out what the new requirements mean for local authorities and will draw on established good practice—for example, the role of a trusted person to offer practical and emotional support to care leavers.
On that basis, I hope I can rely on the Committee’s support for clause 7.
The Chair
With this it will be convenient to discuss new clause 40—National offer for care leavers—
‘In the Children and Social Work Act 2017, after section 2 insert—
“2A National offer for care leavers
(1) The Secretary of State for Education must publish information about services which care leavers in all areas of England should be able to access to assist them in adulthood and independent living or in preparing for adulthood and independent living.
(2) For the purposes of subsection (1), services which may assist care leavers in adulthood and independent living or in preparing for adulthood and independent living include services relating to—
(a) health and well-being;
(b) relationships;
(c) education and training;
(d) employment;
(e) accommodation;
(f) participation in society.
(3) Information published by the Secretary of State under this section is to be known as the ‘National Offer for Care Leavers’.
(4) The Secretary of State must update the National Offer for Care Leavers from time to time.
(5) Before publishing or updating the National Offer for Care Leavers the Secretary of State must consult with relevant persons about which services may assist care leavers in adulthood and independent living or in preparing for adulthood and independent living.
(6) In this section—
‘care leavers’ means—
(a) eligible children within the meaning given by paragraph 19B of Schedule 2 to the Children Act 1989;
(b) relevant children within the meaning given by section 23A(2) of that Act;
(c) persons aged under 25 who are former relevant children within the meaning given by section 23C(1) of that Act;
(d) persons qualifying for advice and assistance within the meaning given by section 24 of that Act;
‘relevant persons’ means—
(a) such care leavers as appear to the Secretary of State to be representative of care leavers in England; and
(b) other Ministers of State who have a role in arranging services that may assist care leavers in or preparing for independent living.”’
This new clause would introduce a new requirement on the Secretary of State for Education to publish a national offer detailing what support care leavers are entitled to claim by expanding the provisions in the Children and Social Work Act 2017 which require local authorities to produce a “Local offer”.
Catherine McKinnell
I will speak to clause 8. Expert reviews have shown that many care leavers face barriers to securing and maintaining affordable housing. Too many young people end up in crisis and experiencing homelessness shortly after leaving care. Although housing and children’s services departments are encouraged in current guidance to work together to achieve the common aim of planning and providing appropriate accommodation and support for care leavers, that is not happening consistently in practice.
To enable better joined-up planning and support for care leavers, the clause will require local authorities to publish their plans, setting out how they will ensure a planned and supportive transition between care and independent living for all care leavers. Our aim is for local authorities to co-ordinate and plan the sufficiency of care leaver accommodation, to plan for the right to accommodation for each individual, and to make early, clear planning decisions that are right for each care leaver’s needs.
The clause specifies that the information that the local authority is required to publish includes information about its arrangements for enabling it to anticipate the future needs of care leavers; for co-operating with local housing authorities in assisting former relevant children under the age of 25 to find and keep suitable accommodation; for providing assistance to former relevant children under the age of 25 who are at risk of being homeless, or who are released from detention, to find and keep suitable accommodation; and for assisting former relevant children aged under 25 to access the services they need.
Damian Hinds (East Hampshire) (Con)
The question about securing and keeping accommodation is incredibly important for care leavers; it is closely linked to what the hon. Member for St Neots and Mid Cambridgeshire was saying about financial capacity. What are the Minister’s thoughts on what the default position should be for care leavers in receipt of universal credit? Should there be automatic rent payments from universal credit, or should it be for the individual to manage? Obviously that can change in individual cases, but what should be the default and what discussions has she had with the Department for Work and Pensions?
Catherine McKinnell
As the right hon. Gentleman will know, we work on a cross-Government basis. We have regular conversations with colleagues in various Departments to ensure that the offer we provide to care leavers will give them the best chance to live independently and that the approach of other Departments to these matters complements and co-operates with what this legislation is intended to achieve.
The right hon. Gentleman raises a specific and quite technical question that relates to the work of the Department for Work and Pensions. As I will come on to, we are working hard to re-establish the ministerial working group to support these young people. I am certain that this matter can be carefully considered as part of that work, so I will take it away and feed it on to colleagues. Given the importance of the clause and the changes it will bring to how local authorities work with children leaving care or young people under the age of 25 who have been in care, I urge the Committee to support it.
I turn to new clause 40, tabled by the hon. Member for North Herefordshire, who I believe is not present today.
The Chair
It is within the scope of this debate, so the Minister may respond if she wishes to.
Catherine McKinnell
I am happy to respond to new clause 40, which would require the Secretary of State to publish a national offer for care leavers, mirroring the requirement on local authorities to publish their local offer. There are already examples of additional support provided for care leavers from central Government that complement the support provided by local authorities. Care leavers may, for example, be entitled to a £3,000 bursary if they start an apprenticeship and may be entitled to the higher one-bedroom rate of housing support from universal credit.
We have re-established the care leaver ministerial board, now co-chaired by the Secretary of State for Education and the Deputy Prime Minister. It comprises Ministers from 11 other Departments to consider what further help could be provided to improve outcomes for this vulnerable group of young people.
Damian Hinds
I wonder whether that reconstituted group will pay particular attention to the role of enlightened employers. Bearing in mind the immense breadth of unique life experiences that many people with care experience bring to a business—it will benefit the young person as well as the business—will employers take an extra chance on a care leaver and give them that opportunity? Being in work and having a regular wage opens up so much else in life.
Catherine McKinnell
The right hon. Gentleman raises an important point and advocates powerfully for this vulnerable group of young people. There will indeed be representation on the ministerial group from various Government Departments, including the Minister for business—[Interruption.]
Catherine McKinnell
There will be a Minister from the Department for Science, Innovation and Technology. That area will form part of the discussions, I am sure, as the purpose of the group is to give the best chance to care leavers—this very vulnerable group of young people—and ensure that we as a Government are working collaboratively to make that effective.
We recognise how important it is that care leavers have clear information about the help and support they are entitled to, both from their local authority and central Government Department. We are therefore reviewing our published information to ensure that it is accessible and clear and that care leavers can quickly and easily understand and access all the support they are entitled to. Once that review has concluded, we will consider how best to publish this information. Therefore, I ask for the new clause to be withdrawn and urge the Committee to support clause 8.
Neil O’Brien
This is a good and sensible clause, and the Opposition support its inclusion in the Bill. I would note that although all these clauses are good, they come with an administrative cost.
We have already discussed the importance of ensuring that the measures are properly funded, but I want to press the Minister for a few more insights on clause 8. There is a list of details about the local offer—that it must be published, must anticipate the needs of care leavers—and it refers to how they will co-operate with housing authorities and provide accommodation for those under 25. This is all good stuff.
The discussion that we have just had prefigured the question that I wanted to ask, which is about co-operation with national bodies. The clause is quite focused on co-operation between local bodies and drawing up a clear offer. That is a good thing—although, obviously, some of those housing associations are quite national bodies these days.
In the “Keeping children safe, helping families thrive” policy paper published a while back, the Government set out an intention to extend corporate parenting responsibilities to Government Departments and other public bodies, with a list of corporate parents named in legislation following agreement from other Government Departments. When we were in government, we also said that we intended to legislate to extend corporate parenting responsibilities more broadly, so I wondered about that connection up to the national level. We have already had one excellent and very canny policy idea from my right hon. Friend the Member for East Hampshire about setting the default for care leavers when it comes to how their housing payments are made. The Minister raised a good point about bursaries and making sure that care leavers are clear about what is available to them on that front. However, there is a whole host of other opportunities to write in to some of these—
Damian Hinds
Will my hon. Friend also comment on the particular situation of those young people from care who go on to university? Of course, come the holidays the vast majority of people in higher education go home, but the situation is very different for those who have been in care. Some enlightened universities—including the University of Winchester, in my own county—do very good work in this regard, but will he expand a little on how those young people in higher education can be supported with the offer?
Neil O’Brien
That excellent point is another example of exactly what we are talking about. In one sense, I regret not having an amendment that would insert a specific paragraph about the local offer from national organisations. On the other hand, it is pretty clear that the Minister is very interested in this question and is pursuing it. Anyway, there may even be scope to write that into the Bill as it goes through the Lords.
The DFE’s explanatory notes for the Bill say that, although the housing and children’s services departments are encouraged in guidance—in part 7 of the Children Act 1989, I think—to work together to achieve the common aim of planning and providing appropriate accommodation and support for care leavers, that is not happening consistently in practice; the Minister alluded to that.
My question to the Minister is: what do we know from current practice about where that does not happen and why not? It seems obvious, and something that every well-intentioned social worker—every person who works with care leavers—would want to do. What does the good model of effective provision of that support look like? Are there local authorities that are the best cases of that?
Other than providing the administrative and legislative hook for better gripping of this issue, I do not know whether the Minister has a specific plan to do anything else to try to achieve it more consistently—given that, of all the different things that one wants to join up for the care leaver, the provision of a safe place to live and a stable housing arrangements is probably No.1. Is anything more being done? Does the Minister have thoughts about how that can be done best and where it is done best? Where it has not been done as well as we would hope, why is that?
Darren Paffey
I appreciate your patience, Mr Stringer—this is not the first time I have stumbled over Committee procedure and no doubt it will not be the last. I welcome the Minister’s comments and the inclusion of clause 8, which I strongly support. I want to address the sentiment of new clause 40 as well.
The extension of the requirements around accommodation, extending the Children and Social Work Act 2017, requires councils to publish that local offer. That is crucial. Many of us have served in local government; it is at that local level that these crucial services, which can often make or break opportunities for care leavers, are delivered. The clause also takes steps towards making good on the Prime Minister’s commitment to guarantee care leavers a place to live.
We would all recognise, from the context of our own constituencies, that the barriers faced by care-experienced young people are numerous. The likelihood that good outcomes in life will be harder for them to achieve is simply a fact. It is absolutely right to bolster the local offer, as clause 8 seeks to do. The new provisions will further strengthen what many local authorities, including my own in Southampton, have begun to do over a number of years. As the right hon. Member for East Hampshire suggested, there are measures of good practice under local councils that we now ought to be bringing into this standardisation of the offer.
In terms of a national offer, the new clause certainly has its merits and it is something good to aim for. I had the opportunity to speak to the Under-Secretary of State for Education, my hon. Friend the Member for Lewisham East (Janet Daby), who is responsible for children and families and whose remit this issue comes under. She has agreed to meet me to explore it further, but as my hon. Friend the Minister for School Standards has already said, there is a cross-ministerial group. I really welcome the work that it is doing to take these measures forward, because building on the existing measures, which strengthen that national focus, is crucial. It says to young people with care experience that they matter.
I have worked very closely with young people in care over the years, and I know that too many of them feel let down by the systems there to protect them. This is about showing that the Government get what it is like for them, are focused on acting for their good and doing so from the very top. Having that national focus goes a long way towards making those people’s journey to adulthood stronger and as smooth as possible and towards ensuring that they are fully supported to thrive.
Tom Hayes (Bournemouth East) (Lab)
It is a pleasure to serve under your chairship, Mr Stringer, and it is an honour to follow my hon. Friend the Member for Southampton Itchen, who is a powerful champion for care-experienced people in speaking from his own personal experience—and the fact that he is my office room- mate helps.
I want care leavers to reach their potential and to be active members of society in Bournemouth and Britain. I want them to have the same opportunities in life as other young adults. As young people in care approach adulthood, they need to be supported to think about and plan their future—to think about things such as where they will live and what support they may need to find accommodation, employment and take part in their communities.
But as my hon. Friend just explained, so many care-experienced people are held back. Some of the statistics are truly startling and appalling. The National Audit Office report entitled “Care leavers’ transition to adulthood” identified poorer life outcomes for care leavers as a “longstanding problem” with a likely high public cost, including in mental health, employment, education, policing and justice services. The Department for Education’s 2016 policy paper entitled “Keep On Caring” said that care leavers generally experience worse outcomes than their peers across a number of areas.
Here are the statistics. It is estimated that 26% of the homeless population have care experience; 24% of the prison population in England have spent time in care; 41% of 19 to 21-year-old care leavers are not in education, employment or training, compared with 12% of all other young people in the same age group; and adults who had spent time in care between 1971 and 2001 were 70% more likely to die prematurely than those who had not. It is no wonder that the independent review of children’s social care described the disadvantage faced by the care-experienced community as
“the civil rights issue of our time.”
In reading those statistics, and in reading that report again, I am struck by just how much of a privilege and an honour it is to be in this Committee contributing to the work of the Bill so early in this Parliament. That is why I particularly welcome clause 8, which is a care leaver-led change that responds directly to the voices of care-experienced people and care leavers.
While we are talking about clause 8, I want to dwell briefly, as my hon. Friend the Member for Southampton Itchen did, on the good practice that exists in local government, particularly in my patch of Bournemouth, where Bournemouth, Christchurch and Poole council has done a couple of things to respond to, work alongside, and listen to care leavers and care-experienced people. That includes the 333 care leavers hub in Bournemouth, which is a safe space for care leavers to visit and relax, and which focuses on wellbeing and learning by helping to teach people practical skills from cooking to budgeting. Care-experienced young people also take part in the recruitment of social workers, sitting on interview panels to make sure that potential social workers have the necessary skills to support care-experienced people.
There is good practice in our country, but that good practice is not consistent across the country. I therefore welcome the efforts in this clause—indeed, in much of the Bill—to make sure that we have that consistency. Requiring the publication of information will mean that care leavers know what services they can access, and, critically, that professionals feel supported to advise on and signpost offers. When professionals have huge demands on their time, and face significant struggles in delivering support, having that additional support available to them will be critical.
I therefore commend this clause, because it is a care leaver-centred approach, a pragmatic approach, and, frankly, a much-needed approach.
Catherine McKinnell
I thank my hon. Friend the Member for Southampton Itchen for his powerful and personal testimony, and for his clear commitment to these issues. I also thank my hon. Friend the Member for Bournemouth East for his clear and important contribution.
My hon. Friends have set out the reasons why we are providing that continuity of support when care leavers reach the age of 18, through the Staying Put programme, and why we are now legislating to add Staying Close to the duties of local authorities. It is to provide that care to leavers; to help them to find suitable accommodation and access services, including those relating to health and wellbeing support; and to help them develop and build their confidence and their skills as they get used to living independently. It is also why we are investing in family-finding, mentoring and befriending programmes to help care leavers to develop those strong social networks, which they can then turn to when they need advice and support.
As hon. Members have rightly said, it is really important that care leavers are supported to get into education, employment or training—the right hon. Member for East Hampshire clearly said that as well. That is why a care leaver who starts an apprenticeship may be entitled to a £3,000 bursary, why local authorities must provide a £2,000 bursary for care leavers who go to university, and why care leavers may be entitled to a 16-to-19 bursary if they stay in further education.
On the question raised by the right hon. Member for East Hampshire, more than 550 businesses have signed the care leaver covenant, offering care leavers a job and other opportunities, and we continue to deliver the civil service care leavers internship scheme, which has resulted in more than 1,000 care leavers being offered paid jobs across Government. We have a real commitment to improving education outcomes for children in care, which will help to support them into adulthood and reduce the likelihood of them not being in education, employment or training. We will continue to support that.
The hon. Member for Harborough, Oadby and Wigston asked how the measure in this clause interacts with national offers. The Government set out guidance for local authorities on the duties and entitlements for care leavers, and we are working to develop the detail of those proposals to make sure that local authorities work together with the Government to improve support for care leavers. With specific reference to higher education, we already have a number of duties to support eligible care leavers in higher education. It will certainly be part of the expectation of the local offer that those options are open to care leavers. It is an important aspect to support.
In response to my hon. Friend the Member for Southampton Itchen, we absolutely agree about bringing the good practice of local authorities into the local offer. We work closely with a number of good local authorities, and there is a lot of really good practice around. The Government intend to bring those authorities into our work so that we have updated guidance to ensure that best practice is spread as far, wide and consistently as possible. With that, I urge the Committee to support clause stand part.
Question put and agreed to.
Clause 8 accordingly ordered to stand part of the Bill.
Clause 9
Accommodation of looked after children: regional co-operation arrangements
Question proposed, That the clause stand part of the Bill.
The Parliamentary Under-Secretary of State for Education (Stephen Morgan)
It is a pleasure to serve under your chairmanship, Mr Stringer. I look forward to working through the measures in this landmark Bill with all Members, as has been the spirit so far.
The children’s social care market is not working effectively. The Competition and Markets Authority and the independent review of children’s social care recommended a regional approach to planning and commissioning children’s care places. My Department will support local authorities to increase the number of regional care co-operatives over time. As Members will have noted, the clause refers to those as “regional co-operation arrangements”. As a last resort, the legislation will give the Secretary of State the power to direct local authorities to establish regional co-operation arrangements.
Where a direction is in place, regions will be required to analyse future accommodation needs for children, publish sufficiency strategies, commission care places for children, recruit and support foster parents, and develop or facilitate the development of new provision to accommodate children. We expect regional care co-operatives to gain economies of scale and to harness the collective buying power of individual local authorities. I hope that the Committee will agree that this clause should stand part of the Bill.
Neil O’Brien
Regional co-operation is something that the previous Government were extremely enthusiastic about and worked to build up, so the Minister will not be surprised to hear that we support the clause. The previous Government’s “Stable Homes, Built on Love” policy paper said that the Government would work with local authorities to test the use of regional care co-operatives—regional groupings of authorities to plan, commission and deliver care places—in two areas. Those two pathfinders would trial an approach within the legal framework, with a view to rolling it out nationally following evaluation as soon as parliamentary time allowed. Were we in office, I suspect that we would be very much considering the same clause. This Government have announced that those two pathfinders are going ahead, in Greater Manchester and the south-east, from this summer.
When we consulted about the idea—it is a good idea —there was a lot of support, but there were also a lot of concerns and questions about the size of the groups, the risk that they would be too removed from the child, and the loss of relationships with small providers in particular. As the Minister said, this is a recommendation from previous work, including from the independent review of children’s social care, which we commissioned. Obviously, we hope that such groups will be useful in providing local authorities with greater purchasing power and more options when they are securing accommodation for children in care, but we think it is important to be clear about the objectives to avoid any unintended consequences. I have come to think that, often, it is when we all agree that we are doing a good thing that we should ask ourselves the difficult questions to ensure that we are not making a mistake.
The key issue in the “children’s home market”—I put that in scare quotes, because I hesitate to use the phrase in the current context—is a lack of supply, which leads to children being placed far away from their roots and support networks in accommodation that does not always match their care plan. We then see children going missing and having repeated placement moves. I wonder whether the Minister will put on record in Committee the aims for the regional care co-operatives, other than purchasing power, and how they will address the other issues.
Will the Minister respond to some specific issues raised in our consultation? One issue is that it is harder for smaller providers and specialist charities, which are obviously part of the offer for children in care at the moment, to engage with regional care co-operatives. What does he think about that risk and what does he plan to do about it?
Munira Wilson
It is a pleasure to serve under your chairmanship, Mr Stringer. I will ask the Minister a couple of questions about clause 9 that I hope he will address when he responds. We support its intent, but I want to understand what safeguards or guidance will be put in place to ensure that children in care in areas where these regional co-operatives are active do not inadvertently end up far away from their families.
We already know that about a fifth of children in care are placed over 20 miles away from their families and almost half are living outside their local authority area. In some cases, it is important that a child is moved reasonably far away for safeguarding reasons, but often that is not the case. I know from having spoken to care-experienced young people and to the Become Charity, which has done quite a lot of research into the impact of children being moved far away from home, that that can affect their mental health, that they can feel isolated and lonely having moved away from family and friends, and that it can cause stigma in the school or college environment. I want to understand how the Minister intends to ensure that young people are not moved further away than they need to be when these regional co-operatives are in place.
Damian Hinds
Again, as hon. Members have said, we support this approach and it is the approach that we were taking. It is also true that when everybody agrees on something, it is usually the point of most danger for making bad law. It is important to have these Committee proceedings and proper scrutiny.
I was personally never keen on the name of regional co-operatives, although I do not think the word “co-operative” actually appears in the Bill. We can, of course, have co-operation without having a co-operative. This legislation is actually about regional co-operation arrangements.
There are three different types of potential co-operation arrangement: first, for strategic accommodation functions to be carried out jointly between two different local authorities; secondly, for one to carry out the duties on behalf of all; and thirdly, for a corporate body, effectively a separate organisation, to be created to do that. I imagine that Government Members will have different views depending on which of those three forms the arrangements take. Will the Minister say which of those he expects to be most common? As well as the pilots, there have no doubt already been formal and informal conversations with local authority leaders in children’s services in many different areas.
I am keen to know how this arrangement is different from some arrangements that may already take place. For example, the tri-borough children’s services arrangement in London—I will try and get this right—between Westminster, Kensington and Chelsea, and Hammersmith and Fulham. Presumably, some of those functions are administered in common there, so how will this be different?
Neil O’Brien
I probably should have asked the Minister about scale. In the two pilots, we have Greater Manchester, which is just under 3 million people, and the south-east, which is roughly 3 million people. I do not know what the Government’s expectations about scale are and whether they would continue to support something like the tri-borough arrangement, which is obviously much smaller.
Damian Hinds
My hon. Friend, as ever, makes a very apt point. Where we end up on that continuum of scale depends on what we are going after most. Of course, we want all those things. For purchasing power, a bigger scale is better, but for close and easy working relationships, a smaller scale is sometimes better. When we are talking about children, and the placement of vulnerable children, that may well push us towards the smaller end of the scale.
Perhaps it is possible to perform different functions at different levels, with some functions still being performed by the individual local authority. Even then, as my hon. Friend often rightly says, there is an enormous difference in scale between London local authorities, which are actually quite small even though they are in our largest city, and Birmingham, which is one enormous authority. It might be argued that doing some things at a sub-local authority level makes sense in a very large local authority area, but as I say, it might be possible to do some things as the single local authority, some things at a larger level, and some things—presumably principally in terms of purchasing leverage—on a wider scale again.
If regional co-operation arrangements are not materially different in practice from something that already exists in co-operation between local authorities, even if that is on a smaller scale than what is envisaged, is legislation actually necessary? If it is not, we probably should not legislate. I would like to understand a bit more about the legislative basis that is currently missing.
Finally, the Bill sets out that the Secretary of State may add to the definition of the strategic accommodation functions that we have listed in proposed new section 22J(3) of Children Act 1989. What type of additional functions does the Minister have in mind?
Tom Hayes
I rise to speak in favour of regional co-operation arrangements, primarily because of what we have seen in two important reviews or evaluations. The recent independent review of children’s social care that I referred to highlighted a system at breaking point, as we also heard from the Minister. The insight from that report was that how we find, match, build, and run foster homes and residential care for children in care radically needs to change. When the Competition and Markets Authority looked at this area, it also identified major problems, such as profiteering, weak oversight and poor planning by councils—the verdict on the system is damning.
The independent review recommended that a co-operative model should sit at the centre of bringing about change. The values of our movement could provide the loving homes that children in care need. I particularly support this clause because this feels like a very Labour Government Bill—one that has at its heart the co-operative model that is obviously such a big part of our labour movement.
My hope is that regional care co-operatives could gain economies of scale and harness the collective buying power of independent local authorities to improve services for looked-after children. There are obvious benefits to using a co-operative model to solve those problems—the values of self-help, self-responsibility, democracy, equality, equity and solidarity apply directly to how these regional care co-operatives would be run. In a social care market that has been described as broken by the Minister and by those reports, it is critical to bring the co-operative model more into what we provide.
Stephen Morgan
I thank hon. Members for their thoughtful comments, suggestions and questions. On the point that the hon. Member for Harborough, Oadby and Wigston made about learning from the pathfinders, the Department has consulted widely with the sector on the proposals for regional care co-operatives. Learning from the pathfinders has shaped the proposed legislation and the definition of the strategic accommodation functions. We will develop expertise in areas such as data analysis and forecasting, as well as targeted marketing, training and support for foster carers. Working collectively with improved specialist capabilities should allow for greater innovation so that local areas are better able to deliver services for children in care.
I turn to the points made by the hon. Member for Richmond—
Stephen Morgan
My apologies. I did know that, but I was trying to be impressive by remembering the hon. Lady’s constituency and I got it badly wrong.
On the hon. Lady’s point about where placements should be, local authorities will continue to have the same statutory duties to find the most appropriate place for looked-after children, including that they should live near home, so far as is reasonably applicable. Regional care co-operatives will assist local authorities with these duties. Placement shortage is a key driver of children being placed in homes far from where they live; regional care co-operatives should improve that by increasing local and regional sufficiency, making more places available locally for children who need them.
Neil O’Brien
Will the Minister confirm that—as I think is the case—the Government would use their powers under the clause to impose regional co-operation agreements only as a last resort, and that we would not push this on everybody who does not want it?
Stephen Morgan
The shadow Minister is absolutely correct. We want to work collaboratively with local authorities in rolling this out. We will not force local authorities to do so. I thank him for enabling me to make that clear.
Question put.
Damian Hinds
Forgive me, Mr Stringer; I know that the Minister has finished, but may I speak again, with leave?
The Chair
I have put the Question. I am sorry, but you have missed the opportunity.
Question agreed to.
Clause 9 accordingly ordered to stand part of the Bill.
Clause 10
Use of accommodation for deprivation of liberty
Neil O’Brien
I beg to move amendment 24, in clause 10, page 16, line 39, at end insert —
“(8A) After subsection (9) insert —
‘(10) Where a child is kept in secure accommodation under this section, the relevant local authority has a duty to provide therapeutic treatment for the child.’”
This amendment would place a duty on local authorities to provide treatment for children in secure accommodation.
Neil O’Brien
We have come to a particularly serious clause—not that the other clauses are not serious, but the use of deprivation of liberty orders for children is always deeply troubling, as is the rise in the number of children who are subject to them. I share the wish of the Children’s Commissioner to see an end to this practice and an end to the use of unregistered provision.
We have seen an increase in the number of young children—including two aged seven last year and 200 under 13—given deprivation of liberty orders. There is nothing in the Bill to differentiate by the child’s age or stage. What consideration has the Minister given to that point? There is something about the use of the orders on very young children that is particularly striking.
When a young child goes into secure accommodation, the Secretary of State has to sign it off, but no sign-off is required from the Secretary of State on deprivation of liberty orders. Why not? The Government are keen on consistency elsewhere in the Bill. Will they bring the same consistency to this clause?
More broadly, do we not need greater clarity on the mechanism for restricting children’s liberty outside a secure institution? I am sure that Members of the other place will be very interested in that question. As the Children’s Commissioner has written, some of the children concerned have physical and learning disabilities, and many are at risk of criminal or sexual exploitation or both. Will the Minister act on the Children’s Commissioner’s recommendation and introduce a proper legal framework and guidance? We believe that much more clarity is needed in the Bill on therapeutic care for those who are under a deprivation of liberty order. Historically, there has been a lot of focus on containment. This amendment is, I suppose, our legislative prod to take the opportunity to think about what therapeutic help a child needs and how to deliver it.
Damian Hinds
Clause 10 will amend the Children Act 1989 such that local authorities can authorise deprivation of liberty of children other than only in a secure children’s home, and will change the term “restricting liberty” to “depriving of liberty”.
In the secure children’s home sector, a distinction is often made between what are called justice beds and welfare beds. There are also children detained under the Mental Health Act 1983 on secure mental health wards and in psychiatric intensive care units, or on non-secure wards. I am assuming that we are talking today only about what are known as welfare beds—I say “beds”, but normally the entire facility is either one or the other.
To speak on justice beds briefly, there has been a big fall in this country since 2010 in the number of children who are locked up in the criminal justice system: the numbers are down from about 2,000 in 2010 to only around 500 now. That has partly been because of a fall in crime, and in the particular types of crime for which young people used to be locked up, but it is also because of the good work of youth offending teams. Most of those children are older and would typically be in a young offenders institution when aged 15 to 17, or indeed, 18 to 21. The very small group of children who are in the secure children’s home sector are a very difficult and troubled cohort of youngsters with complex pasts. I take a moment to pay tribute to the staff; it is an extraordinary career decision to go into that line of work, and they do it with amazing dedication.
The welfare bed part of the secure children’s home sector is where somebody has had their liberty restricted not because of something they have done, but because of something they might do—because of the danger or threat they pose either to themselves or others. It is an enormous decision to take to deprive anybody of liberty on those grounds, but particularly a child. As with those children who are in the criminal justice part of the secure children’s home sector, these are typically extremely troubled children.
On the change in clause 10 to allow local authorities to house those children somewhere other than a secure children’s home, the obvious question to the Minister is “Why that, rather than ensuring that a secure children’s home is properly catering to the needs of that cohort of children?” I am not saying that it is the wrong decision, by the way, but I am interested to know, and it is good to have it on record, why it is a better decision to say, “Let’s take some or all of these children and house them in a different type of facility.” What have the Minister and the Secretary of State in mind for the alternative accommodation that would be set out in regulations? For the benefit of the Committee, and again for the record, it might also be helpful to define what is different. The Minister might clarify the definition of a secure children’s home and explain what it is that we need to deviate from.
My other question is about the change in phraseology. We are talking about moving from the restricting of liberty to the depriving of liberty. I understand from the explanatory notes that this tries to reflect the reality, but it is a legitimate question whether it is a strictly necessary change to make and what the reasoning is. Even when we do deprive people of liberty, we do not deprive them of all their liberty. There are degrees of restriction. We have this as a feature in the criminal justice system, and though this is a different cohort of children, some of the same principles may apply. We may be able to get a lot of the benefit we are looking for from restricting someone’s liberty rather than entirely depriving them of it. I wonder if the Minister might say a word about that distinction and about whether the Government have received representations on the change in wording.
Ian Sollom
My understanding is that this change follows a trend of children being deprived of their liberty outside the statutory route by being housed in unsuitable accommodation not registered with Ofsted, often far from home and family. That has been partly addressed in the questions from the hon. Member for Harborough, Oadby and Wigston.
The success of this provision will depend on the regulations. What actually makes a setting capable of being used for the deprivation of liberty? Will there be a requirement with respect to education in that setting? Will they need to be registered with Ofsted? It is not entirely clear. When will regulations relating to this provision be brought forward? Is it the intention that they will mirror the scheme for the secure accommodation?
The law around the deprivation of liberty is incredibly complex. Without proper legal advice and representation, it is very hard for families to understand what is going on and what options they have. It is not clear yet what legal aid will be available to families or the child themselves when an application is made under the new route. Can the Minister clarify what will be available with respect to legal aid, or put a timetable on when we will get that clarification?
Stephen Morgan
Amendment 24 seeks to place a legal duty on local authorities to provide therapeutic treatment for children placed in secure accommodation—that is, a secure children’s home. The Government’s view is that the amendment is not necessary as there are a number of existing legal duties on local authorities to ensure that wherever children are placed, including in secure accommodation, their needs are met, including the needs for therapeutic treatment. This is part of the duty on local authorities, under primary legislation, to safeguard and promote the welfare of any child that they look after.
Neil O’Brien
I am grateful to the Minister for his informative speech, but can I press him to respond to the specific points made by CAFCASS and the Children’s Commissioner? The Minister is alluding to some of them as he goes along. The first is about requiring explicit Secretary of State approval beforehand. The second is about specifying the frequency of review, particularly for younger children. The third is about having an automatic requirement for children’s protection plans as the child comes out. The fourth, which the Minister has alluded to, is about them being put into illegal settings, and whether something legislative should be done at this point to stop that from happening at all.
Stephen Morgan
I am coming to the end of my speech and hope to answer the points that the Opposition spokesperson made. I will certainly take away the issues that he raised.
I thank all Members for their contributions and questions on this very important matter. On consistency, the views of the Children’s Commissioner and age, I know that this point was raised in the other place only yesterday by a former Minister, and I am grateful for that. It is worth saying here, too, that the child rights impact assessment is informing our work on the Bill. I give the shadow Minister the assurance today that I will take on board these comments.
Neil O’Brien
Is the child rights impact assessment for the Bill published so that we can see it?
Stephen Morgan
There is no legal obligation for England to publish that assessment, but we are certainly using it to inform our work on the Bill.
Neil O’Brien
I think Ministers have said in previous sittings that it will be published during the process of scrutiny, along with the impact assessment. Is that still the case?
Stephen Morgan
I am referring to the conducted children’s rights impact assessment, where children are directly impacted by the policies and/or particular groups of children and young people are more likely to be affected by others. As I mentioned, there is no requirement to publish these documents in England. However, the documents are currently under review and we will advise on our next steps shortly. More broadly, with regards to the impact assessments, these will be published in due course.
Neil O’Brien
I thought I had heard Ministers say previously that they were planning to publish this for our benefit—that we would get both the impact assessment and the children’s rights assessment. Perhaps it is me who is sowing confusion and the Minister may still intend to publish this document. I cannot see any reason why the Government would not publish it, so can I get an assurance that that is going to be published?
Stephen Morgan
To state this clearly, the impact assessment has not yet been published but is obviously informing our work. Obviously, various different assessments are undertaken and I will certainly get back to the hon. Member on those points.
Munira Wilson
The Minister has said a number of times that, by law, the child rights impact assessment does not have to be published. In the interests of transparency and for all of us to do the right thing by children, does he not agree that even if he does not have to publish it, he really ought to do so?
Stephen Morgan
To be clear, we will be publishing the regulatory impact assessments. We will certainly be using the evidence from the children’s rights impact assessments to inform our work.
I turn to the points raised by the Opposition spokesperson on placements of children under the age of 13. Depriving a child of their liberty must always be a last resort, but it is sometimes necessary to keep that child and others safe. These children are some of the most vulnerable in our society. We must do all that we can to keep them safe and help them get on well in life. When a child under the age of 13 is deprived of their liberty and placed in a secure children’s home, the local authority must obtain approval from the Secretary of State before applying to the court. That requirement is set out in regulations that reflect the added seriousness of depriving children so young of their liberty.
The Opposition spokesperson and the right hon. Member for East Hampshire (Damian Hinds) also made a number of broader points about child protection plans and deprivation of liberty. Local authorities’ care-planning duties are clear that when there are looked-after children, they must have a long-term plan for a child’s upbringing, including arrangements to support their health, education, emotional and behavioural development, and their self-care skills.
The statutory guidance “Working together to safeguard children 2023” is clear about the actions that local authorities and their partners should take, under section 47 of the Children’s Act 1989, if a child is suffering or likely to suffer significant harm, as well as the support that should be provided under section 17. If there is a concern about a child’s suffering, or if a child is likely to suffer significant harm, the local authority has a duty to make an inquiry under that Act. “Working together to safeguard children” sets out the actions that the local authority and their partners must take when there are child protection concerns. That includes putting in place child protection plans when concerns are submitted. I hope that the Committee agrees that the clause should stand part.
Neil O’Brien
I hope that we can clear up the confusion about whether we will see the children’s rights assessment. I cannot see any good reason why we would not be able to see that perfectly routine assessment. None of these things is the end of the world, but not having the impact assessment of the thing that we are quite deep into line-by-line scrutiny of seems to further compound this problem. Obviously, no one can defend that; it is not good practice.
I slightly pre-empted what the Minister said—he had scribbled some last remarks—but I was glad that he came to some of the points raised by CAFCASS and the Children’s Commissioner. I raised them partly because I know that their lordships will be extremely interested in these specific questions. There probably is scope for improvement of this clause to do some of those other good things, because this is such a serious issue for those very young children.
We will not vote against clause stand part, but I will press our amendment to a vote. I heard what the Minister said, but I just make the point that there is scope for improvement in the clause, and I suspect that their lordships will provide it.
Question put, That the amendment be made.
Stephen Morgan
Clauses 11 and 12 will strengthen Ofsted’s regulatory powers to allow it to act at pace and scale when that is in the best interests of children. Specifically, clause 11 strengthens Ofsted’s powers to hold provider groups—parent undertakings, in legislation—to account for the quality of the settings that they own and control. This ensures that Ofsted can take the quickest and most effective action to safeguard vulnerable children, without adding duplication within the existing regime. It will allow Ofsted to look across provider group settings as a whole and take action at provider group level, rather than being limited to doing so setting by setting as it is now. It will also ensure that a provider group is accountable for the quality of the settings that it owns.
Where Ofsted reasonably suspects that requirements are not being met in two or more settings owned by the same provider group, it will be able to require senior people in the provider group to ensure improvements in multiple settings. The requirement applies both to settings operated by a single provider and to multiple providers owned by the same group. Ofsted will be able to request that the provider group develops and implements an implementation and improvement plan to ensure that quality improves. The plan will need to address the issues identified by Ofsted and be approved by Ofsted if it is satisfied that the plan will be effective in addressing the issues.
The clause gives the Secretary of State the power to make regulations to provide that non-compliance by the provider group means that the providers that it owns are not fit and proper persons to carry on a setting. That will prevent a person from being registered in relation to new settings if their owner has failed to comply with the relevant requirements under these provisions. That should act as a deterrent and ensure compliance with the requirements.
Clause 12 gives Ofsted the power to issue monetary penalties to providers that have committed breaches of requirements, set out in or under the Care Standards Act 2000, that could also be prosecuted as criminal offences, including operating a children’s home without registering with Ofsted. Ofsted will also be able to issue a provider group with a fine for non-compliance with the requirements set out in clause 11. The fine will be at Ofsted’s discretion and is unlimited in legislation. That will act as a significant deterrent, so that provider groups comply with these requirements. Clause 12 ensures that Ofsted has an alternative to prosecution where that is currently the only enforcement option against those seeking to run a children’s home without registration. Ofsted will not be able to impose a monetary penalty on a person for the same conduct where criminal proceedings have been brought against them in relation to that conduct.
To act as a deterrent and to ensure transparency for the public, the clause gives the Secretary of State the power, by regulations, to require Ofsted to publish details about the monetary penalties that it has issued. Ofsted must also notify local authorities when a monetary penalty has been issued, as it is currently required to in relation to other enforcement actions that it takes. Finally, the clause provides that the issue of a monetary penalty could be used as grounds for cancellation of registration.
Neil O’Brien
We are entering a whole new section of the Bill. I will make a number of points now that we could come back to when we debate future clauses, but I hope we will not have to. I hope that we can have discussions about the principle and philosophy now and we might be able to move faster later, but we can come back to them if necessary.
As we turn to the clauses dealing with children’s homes, I want to start by checking that the Minister has the same basic understanding of the situation, and the same philosophical take on what we are trying to do, as I do. First and most importantly, there is a question about the underlying structural problems that have driven high costs for local authorities in the provision of residential care for children and young people, and there is a second question about the best approach to tackling that, both legislatively and non-legislatively.
On the first, does the Minister agree with me, at least in principle, that the main issue driving the high costs is a shortage of foster care, which is driving local authorities to send children into expensive children’s homes at best, or into unregistered provision at worst? Research by Ofsted in 2022 suggested that residential care was part of the care plan for just over half of the children whose cases it reviewed. To put that the other way round, almost half of children who ended up in residential care should ideally not have been there. Crucially, the research shows that the original plan was for over one third of children to go into foster care.
Although the Bill makes changes to the provision of information about kinship care, which is good, there is nothing that will produce the step change that we need to increase the number of foster carers, which is the thing that would really take down the demand and the high costs. That point is common to the discussions that we will have about cost-capping social workers, cost-capping individual care homes and reviewing whole entities. I do not think that those measures are bad; I just do not think that they are ultimately the underlying solution. That is a point that the Committee will hear me make several times today.
In his independent report commissioned by the previous Government, the Member for Whitehaven and Workington (Josh MacAlister) highlighted that in the year ending March 2021,
“160,635 families came forward to express an interest in becoming a foster carer, and yet just 2,165 were approved”.
That is just 1.3% making it through. It might be that some of those were just initial approaches and not all of those people were deadly serious, but that is still a very small share. He continued:
“Local authorities perform a wide range of roles and appear to be struggling to provide specialist and skilled marketing, recruitment, training and support for such an important group of carers. In 2020/21 recruitment and retention among independent fostering agency services led to a net increase in capacity of 525 additional households and 765 additional foster care places. In contrast, there has been a decrease in capacity of 35 households and 325 places in local authorities over the same period”.
By definition it is quicker, and in quite a lot of cases better, to provide foster care than to build a new children’s home. I want to press the Minister on what he thinks is the explanation for that 99% gap between those expressing an interest in fostering and final approvals. What is he doing to close that gap? He will be aware that there is a perception that it is almost impossible to become approved as a foster carer. We looked at this in my family some years ago. We started in on it through my work as a constituency MP; I have met many constituents who are foster carers. They are incredible people and I pay tribute to them. A woman I know well has fostered 70 children as well as adopting. I honestly think these people are amazing.
The Government really need to use the Bill—this rare legislative slot, as one of the Ministers said—to increase the number of foster and kinship carers. Publishing information is good, but it will not change much unless it is accompanied by a radical attitude to approvals by local authority social work teams. When the alternative—which we are getting to in this clause—is children being sent miles from home, placements breaking down, children going missing and high costs to local authorities, there is obviously a burning platform for change.
If I were the Minister—he is free to take this suggestion or not—I would commission a month-long desktop review to look at the pipeline and all the decisions to reject applications to be foster carers that got fairly far down the track, and understand what can be learned from them. That could shape amendments either here or in the other place and be a huge benefit to him. I can think of a senior official in a Government Department—someone the Government trust to run a major public service—who has two kids, provides a loving home and wanted to foster but was turned down. There are many such cases. Everyone knows the phrase “too many books in the house”, but I strongly encourage Ministers to dig into the underlying question of why we lose so many opportunities to get the foster carers that would take off the pressure that we are trying to take off with these clauses.
A key recommendation of the independent review of children’s social care led by the hon. Member for Whitehaven and Workington was to introduce mixed models combining residential and foster care, particularly for older children, who are the fastest growing part of this cohort. That was part of our brief for the initial pathfinder sites for the regional care co-operatives, which I mentioned in the debate on a previous clause. What assessment has the Minister made of that approach? What impact does he think its adoption might have? Is there any interesting early data from the pilots in Greater Manchester and the south-east?
Speaking of mixed models, I encourage the Minister to look at the incredible work of the Royal National Children’s SpringBoard Foundation, which, as he knows, does amazing work looking after care-experienced and edge-of-care children in a network of state and independent schools. It has been working with the DFE since 2020—something I am very proud that we brought in—and has provided incredible, transformative opportunities for disadvantaged young people. I encourage the Minister to build on that and go further.
On the specifics of clause 11, after the terrible abuse of children supposedly in the care of the Hesley Group, it is absolutely right that the Government are trying to identify systemic safeguarding problems in organisations that manage multiple children’s homes, independent fostering agencies and residential special schools. Our only concern, which is quite serious, is that we should allow for rapid action, not something that drags on and becomes a time and resource-consuming process.
I heard what the Minister said in introducing the clause about providing an alternative to prosecution, but I do not want to lose sight of the importance of prosecution. My noble Friend Baroness Barran told me that when she was a Minister in the Department for Education, she was already able to request inspections of every home in a group where one was judged to be failing, and did so on at least one occasion. Ultimately, we need experienced people to go into a home quickly and see what is actually happening. I think this is within the spirit of what the Minister said, but I hope he would agree that there is often no better alternative to actual inspection and actual prosecutions.
To use an example from a very similar area, the Department can also request an “improvement plan”, which is the main vehicle proposed in these clauses, in the case of independent schools, but that does not always work well in practice. The reasons for that are instructive for the kinds of issues that I hope Ministers will think about here. What ends up happening is that plans are sent in varying degrees of adequacy, and time—in some cases literally years—can be wasted with a lot of letter writing back and forth. I urge the Minister to think about the action he wants in those kinds of cases. Imagine being in the middle of a drawn-out improvement plan process in another case like the Hesley Group case—and that is before the inevitable appeals, which the clauses provide for, kick in.
We have not tabled an amendment to do this—I wonder, though, about the other place—but we think that the Minister needs to confine the improvement plan idea to more minor administrative cases or lower-level concerns. That is where it might be more appropriate. We worry that we might get similar processes to those that we have seen in independent schools, where we have a resource-intensive, rather bureaucratic and slow process that goes on for a long time with a lot of back and forth and appeals. Ultimately, we sometimes just need to get to the point. That is our broad concern.
Stephen Morgan
I thank the shadow Minister for his contributions and questions. He made a number of practical points and asked a number of specific questions.
Terminally Ill Adults (End of Life) Bill (Second sitting)
Tuesday 28th January 2025
(2 days, 18 hours ago)
Public Bill CommitteesRead Full debate Terminally Ill Adults (End of Life) Bill 2024-26 View all Terminally Ill Adults (End of Life) Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 January 2025 - (28 Jan 2025)
The Chair
We are now sitting in public and the proceedings are being broadcast. Before we begin, I remind Members to switch electronic devices off or to silent. Tea and coffee are not allowed during sittings. Before we start hearing from the witnesses, do any Members wish to make declarations of interest in connection with the Bill? No.
We will now hear oral evidence from Professor Sir Chris Whitty, chief medical officer for England, and Duncan Barton, chief nursing officer for England, NHS England. Before calling the first Member to ask a question, I remind Members that questions should be limited to matters within the scope of the Bill. I also remind Members that time is tight, so please keep your questions to the point. We must stick to the timings in the sittings resolution that the Committee has already agreed. For this session, we have until 10.05 am. Will the witnesses please briefly introduce themselves for the record? If you are to give an opening statement, please keep it short.
Professor Whitty: I am Chris Whitty, the chief medical officer for England, and I am also representing the chief medical officer for Wales. One statement, which is on behalf of Duncan and myself, and all the CMOs, is that we are completely neutral on the principles of the Bill, which we consider are entirely for society and therefore for Parliament. Although we are answering technical questions, we will not be answering questions of principle, because we feel that is a societal question. We have made it clear to the medical profession, however, that individual doctors should be able to make whatever statements they wish. Obviously, doctors have strong views on all sides of this argument, as members of society do.
Duncan Burton: Good morning. I am Duncan Burton, the chief nursing officer for England. For transparency, I will say that I am also a volunteer trustee of a hospice.
Naz Shah (Bradford West) (Lab)
Q
“But if any provision of this Act has not been fully brought into force before the end of the period of 2 years beginning with the day on which this Act is passed, that provision (so far as not already in force) comes into force at the end of that period.”
My question is: do you believe that it would be safe to implement this legislation if those provisions had not been fully put in place?
Professor Whitty: If this Bill is passed—I want to stress that; I will say it once, but assume it applies for all the answers I subsequently give—we will clearly need both: a period to make sure that there is technical guidance and legislation, via secondary legislation, because obviously the primary legislation is the Bill; and necessary training for people to be able to do this in an appropriate and dignified way, if that is what Parliament chooses.
Naz Shah
Q
Professor Whitty: That is an absolutely critical question, because it is very important that if the Bill is passed, all parts of society, of whatever ethnicity and of whatever background, have equal access to the Bill—or not, as Parliament determines. That will require adjustment in a variety of ways. Some can be done at a macro level—for example, making sure that everything is translated into the major languages spoken in the United Kingdom—but a lot of it will be to do with the individual interactions that doctors, nurses and other healthcare providers have with individual patients, which must take into account their own starting point, their own knowledge and, most importantly, their own beliefs.
Lewis Atkinson (Sunderland Central) (Lab)
Q
Professor Whitty: I will give my view, and it might be useful to get Duncan’s view on the nursing side, because nurses will often be heavily involved in these discussions.
I would divide the kind of training that is needed into two broad groups: training that is essentially normal medical practice but may need some variation, and things that are clearly specific to this Bill. Issues, for example, around mental capacity—as determined by the Mental Capacity Act 2005—are dealt with every day, in every hospital up and down the country; every doctor and nurse above a certain level of seniority should be able to do that normally. It may require some slight adjustment. There is an absolute expectation within the Act, for example, that the more serious the decision, the greater the level of capacity that someone needs to have. That is already built into the principles of the Act and the way that things are done. I would extend that to the management of end of life, which should be a normal part of medical and nursing practice—we will all die eventually, and that has always been part of medicine, and always should be. That training should be generic, but may need some adaption.
There will then be some specific things that will be necessary for people to understand the legislation, including, in some cases—if this Bill is passed—if they are to take part in the final part of prescribing drugs to patients. It is much more likely that a very large number of doctors and nurses may get involved in the very earliest stages, because someone may raise an issue with their GP, nurse or consultant, who will need to have the basic understanding for that. In my view, the more detailed later stages will require some specific training. I think there will be a gradation of doctors: those who are happy to have the general, initial conversation; those who are happy to have the structured conversation that follows; and a minority who will be happy to go on to take part in the final stages.
It is very important that the wishes of the patient are respected. That is the central point of this. We must start with what is good for someone in their last six months of life, and for their immediate family, but we must also make sure that the wishes of healthcare professionals around this area are absolutely protected, when it comes to conscience and to choice.
Duncan Burton: I am mindful that there are two groups of staff who would potentially be working in this service, if the Bill is passed, but also of the wider workforce. At 2 o’clock in the morning, when a patient wants to have a conversation with somebody about end of life, it is going to be a nurse with them, or a nurse in a care home, or a specialist nurse providing cancer care, so we have to think about the training and support that is required for them, be that around signposting or explaining where they can go to access more information. There is an important part about the entire wider workforce that we need to think about.
Clearly, for those people who are working in such a service, we need to think about the safeguarding elements, and how we make sure there is support through safeguarding training and confidentiality—particularly mindful that some patients may choose not to tell their families about this. We need to think about how we enable and support staff in managing those kinds of circumstances and navigating the legal requirements through the Bill. We need to think ahead about what we need to do in undergraduate training for doctors and nurses, and in the curriculum.
Lewis Atkinson
Q
Professor Whitty: You are absolutely right: it is a completely normal part of medical and wider nursing, and other practice, but particularly medical practice, to consider issues of consent and capacity. It can be that someone says they do not want treatment that is clearly going to be lifesaving. A very well-known example is that of Jehovah’s Witnesses, who choose not to have blood products. If they are bleeding heavily, that is an issue that could lead to the end of their life. Provided they understand that and they have capacity, that has to be respected.
The alternative way—the other thing that doctors have to do—is to give people advice before they have major operations, chemotherapy or other drugs that may in themselves lead to the end of their life, but which also may lead to a benefit. Explaining to people the risks and benefits, including the fact that they may lose their life as a result of the next stage—if someone is at high anaesthetic risk, that is not a trivial risk sometimes with operations—is a very standard part of medical practice that you do from the point that you qualify. Obviously, as people get more senior, they tend to be more experienced in it—and, as with most things, if you get more experience, you generally get better at it.
Sarah Olney (Richmond Park) (LD)
Q
Professor Whitty: If I am honest, I think it would be extremely difficult. If I may, I will explain why, because it is a really important question. Let us take cancer. For the great majority of people with the majority of cancers that are diagnosed tomorrow, the doctor who is seeing them will say, in all confidence, “You have cancer and I expect you to be alive not just next Christmas, but for many years to come.” The fact that they have cancer is not in itself a demonstration that they are going to die. In fact, the majority will not. Almost 80% of people with breast cancer diagnosed tomorrow will still be alive 10 years later, for example.
Equally, there are people who may not have a single disease that is going to lead to the path to death, but they have multiple diseases interacting, so they are highly frail; it is therefore not the one disease that is the cause, but the constellation that is clearly leading them on a path inexorably to a death at some point in the foreseeable future. Exact timings are tricky—we might want to come back to that. I therefore think it is quite difficult to specify that certain diseases are going to cause death and others are not, because in both directions that could be misleading.
Sarah Olney
Q
Professor Whitty: At the extremes —most people are at the extremes—it is very clear what is going to happen. For most people, you can say with confidence, barring some extraordinary accident like being hit by a car on the way out, “You’ll be fine in a year, even though you have heart disease, cancer or whatever.” At the other extreme, there are people who are clearly dying and will die in the next two or three days, and virtually nothing will change that reality.
What we are talking about in the Bill, of course, is a point between those stages, but people will definitely reach a point where there will be an inexorable and, importantly for the Bill, unreversible slide towards a point of death. People can make a reasonable central view, if they are experienced in a particular disease, about when the death is likely to happen, accepting that there is a spread around that. I am sure that the general public and Members of Parliament fully accept that this is not a precise science. This is a central view, and there is a big academic literature around this. Some people will die significantly earlier than they are predicted to; a small number will die very significantly later; and some people will certainly die a bit later or to some degree later. The central view is usually reasonably accurate—that someone is now on a pathway from which there is not going to be a return.
Kim Leadbeater (Spen Valley) (Lab)
Q
Professor Whitty: Duncan, why don’t you take the first bit and I will take the second?
Duncan Burton: In terms of looking for signs of coercion, all of our nursing and clinical staff have safeguarding training, which already looks at things like whether people are under financial coercion or other forms of abuse. That training is already in place and it is extensive across the NHS and social care. If the Bill is passed, we will need to look at how we strengthen that training in relation to spotting the potential signs of coercion in this space as well. Given that that mechanism is already in place, I think that would be an extension, so it is important that we factor that in. I am also mindful, given the scale of colleagues we have working across health and care, that the time between the Bill being passed and its implementation is sufficient that we enable everybody to receive that additional training, if it is required.
Professor Whitty: In terms of strengthening the Bill, as a practitioner, I was relieved that the decision was for the Bill—if it stays this way—to stick with the Mental Capacity Act, and that was for two reasons. First, that Act is used up and down the country by doctors and nurses every day; they know it and they understand it. Although, as you say, it is a large piece of legislation, it is one that people have worked through in practice multiple times. If you ask six or seven doctors, “Does this person have capacity?”, in almost all cases you will get six or seven identical answers, because people are used to using it.
It additionally has the advantage of being tested in the courts. That has gone as far as the Supreme Court, and the various ambiguities that were inevitably in the legislation have been clarified by senior judges. Therefore, to practitioners like me, it feels like a piece of robust and predictable legislation. Within the legislation, it is very important that there are some situations where you will need to call for additional assistance. For example, if someone has a co-existing mental health condition, you will probably want to ask a psychiatrist additionally whether that condition is interfering with the decision taken to the point that someone loses capacity for this very important decision. The level of capacity has to be reasonably high.
My own view is that starting this way is the sensible thing to do. That does not mean there could not be arguments for some additional points, but I cannot immediately—again, as a jobbing doctor—see ones where I think, “This is going to make a big difference.” The fact is that this is founded on a very established bit of well-used and well-recognised legislation.
Kim Leadbeater
Q
Professor Whitty: The further you go up in the seriousness of the decision, the more you would do that. For example, if you were setting a finger that had been broken, you are not going to wait until a psychiatrist has said that you can do that. Within reason, provided that someone gives consent, you will do that. You will be much more cautious about moving forward with things like open heart surgery or deprivation of liberty if you think there is uncertainty. It should be clear. For the majority of people, it is very clear they have capacity or very clear they do not. There is a relatively small—but important—number in the middle where that is less clear and where additional views are relevant, particularly where there is a question of co-existing mental health issues. The fact of the mental health condition does not in itself mean that someone does not have capacity, but what has to be taken into account is, “Do they have the capacity for this decision at this point in time?” That is how the Mental Capacity Act works.
Rebecca Paul (Reigate) (Con)
Q
Professor Whitty: As we have seen in covid, the NHS, like any service, can swing very fast if there is a need for speed. In this case, I think most people in society would say that the key thing is to get this right. Personally, I would rather it was not running against a timeline. You would not want it to drag on forever, because then you have uncertainty for everybody, but I think Duncan and I would both say that two years seems a reasonable starting point. With some things, it might take longer than that to work out how we are going to provide this in the most safe and equitable way—for example, in dealing with minority and other groups. We need to get all that right and, at least at first pass, get it as close to good as we possibly can.
Equally, we may find when we first start using the legislation that there are some things that we had not considered at the beginning, and therefore we need to go back and improve on them because we just had not thought about them in the first way through the gates; that is why I hope that some of the more operational issues are done through secondary legislation and regulation. Inevitably, that is true for many bits of legislation, but it is particularly important here.
I go back to my very first comment: the central person here is an average citizen in their last six months of life. What we do not want is a system very difficult for them to navigate so that they spend their entire last six months of life—if the Bill is passed and they choose to take account of it; they are going to be a minority—stuck in a bureaucratic thicket. We need to keep this simple. My view is that the best safeguards are simple safeguards. Overcomplicating usually makes the safeguard less certain.
Rebecca Paul
Q
Professor Whitty: I think that there is a big difference between the Act coming into initial force—that is, “This is now where the law is”—and the service being provided. On the second of those, I would argue against putting a firm deadline, with a reasonable expectation that the NHS and others should be involved in trying to make plans for this as fast as possible. But if the Bill is passed, we are going to have to sort out multiple different things to get this to work. If we were three months away from being able to get something sorted out, I would not want to have a situation where it all had to start the following day. I think that would make it much harder to provide a safe, fair and secure service.
Duncan Burton: In my understanding, the Bill does not call out the NHS specifically in terms of providing this service. A number of steps would have to be gone through to understand the implications—the operational and training implications, as we have already discussed—to understand the timeline required. For the reasons Chris has outlined and as mentioned earlier, when thinking about the wider implications for the workforce there would need to be sufficient time to be able to work through those.
Rebecca Paul
Q
Professor Whitty: That is a key question, and to me that does seem something that Parliament may want to debate. That is not a question for us, but it is a point of principle one way or the other.
Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
Q
Professor Whitty: First, I have had quite a lot of conversations—not just with the chief medical officer for Wales, but all the other chief medical officers and indeed a much wider range of the medical profession; I wanted to feel that I was giving a central view of the medical profession in terms of the practicalities. My view is that, in a sense, the principles of the Bill are no different between England, Scotland, Wales and Northern Ireland, although the legislation would apply only to England and Wales were it to be passed.
The operational questions we have been talking about will be either subtly or importantly different between the different jurisdictions for a variety of different reasons. I do not think that is a problem, provided it is in secondary legislation and it allows the different jurisdictions to do things in the way that best suits their own set-up. Again, as we saw during covid, different nations will choose to reach the same end state using slightly different practical routes.
Liz Saville Roberts
Q
Professor Whitty: Yes. I think in principle it would be better to be as close as possible, but if there were important practical differences why it was not going to start on the same date, the more important thing would be to get it right rather than to get simultaneous timings.
Daniel Francis (Bexleyheath and Crayford) (Lab)
Q
I also heard what you said about the scaling of decision making, but within the Bill, in some of those scenarios there is no mandating; the word “may” is used rather than “must”. I want to understand your viewpoint on whether it would provide stronger safeguards if those parts of the Bill were tightened to include “must” rather than “may”, and if the reference to capacity were replaced with a separate definition of “ability”, as proposed in our amendments.
Professor Whitty: I am probably not the best person to ask about the exact drafting of the Bill in terms of “may” and “must”, but I can answer the second part of your question, which is really important.
If there were no Mental Capacity Act, there would be an argument, which has been used for a long time, that the Bill would have to define what was meant with a fair degree of clarity. It would not be able to do that with just one clause; there would have to be quite a lot of clauses, if I am honest. All systems of this sort are going to be imperfect. The reason why I think it is sensible to base yourself on the Mental Capacity Act is that it is well used and well understood in practice by practitioners every day. Having a system with two completely separate groups of assessment, one of which has never been tested in the courts or used outwith this Bill, would lead to a whole set of potential complications and ambiguities, which are not there at the moment because we have a well-tested mechanism through the Mental Capacity Act.
People should move away from the Mental Capacity Act with some caution, because I think that will cause as many problems as it solves. It is not clear to me what problem people are trying to solve by doing that, given that the Mental Capacity Act clearly makes the point that the more severe the decision, the greater the degree of capacity that has to be assumed before people can actually take that decision. That is the foundation of some of the disquiet that people have had, but it is central to how the Mental Capacity Act works in practice.
Dr Simon Opher (Stroud) (Lab)
Q
“reasonably be expected within 6 months.”
Is that in line with your thoughts on the matter?
Professor Whitty: I think that is a reasonable point in time provided that, in taking that period into account, Parliament assumes that we mean a central view that this is six months, although it might be before that and it might be after. Other times would be equally reasonable, but if you are going to choose one, then six months is reasonable. It is generally very predictable that someone is going to die in the foreseeable future, but predicting whether that will be in five months or seven months is a lot harder, and there would be some caution.
Notably, in the countries that have chosen to go down an assisted dying route—a variety of different ones have been chosen—a significant minority of people die before they actually get to the point where that occurs because there is uncertainty in both directions. I think that period is as good as any other, but I want people to be clear that this is not an exact science where you can say, for example, “On 20 August.” It is not as tight as saying that a baby is going be born on a certain date. It has a wider spread of uncertainty around it. In the overwhelming majority of cases, that does not mean that it will go on for months or years longer, but there will be some degree of uncertainty.
Dr Opher
Q
Professor Whitty: Duncan may wish to comment for nurses. For doctors, we should be very mindful of the fact that for some doctors, as for some citizens, this is a point of very strong principle indeed, therefore there will be a gradation of people feeling that they can personally be involved in it. I suspect that if they themselves did not feel able to do it—because of conscience or choice, or because they did not feel that they had the necessary skills—the great majority would have no problem referring on, but it might be an issue for some people.
Personally, my view is that we should be able to have the range, provided that people are aware in general that, if one person cannot provide it and then does not wish to discuss it, there are alternative routes. But that really is a matter for Parliament and if Parliament says, “No, actually, that is unfair on the patient, because then the patient is having to go through an extra step,” that is an alternative and perfectly reasonable principle. Parliament is going to have to balance those two principles; that is not for me as a doctor. I just think that that range of opinion needs to be thought through when people are coming to that final parliamentary decision.
Duncan Burton: If I could add to that, again, I think that bit about the wider workforce and how we would support them is really important. We have situations like this already. We have advice professionally around things such as abortions and working in embryo services and fertility, for example, so we need to make sure that the safeguards for our staff are really clear. As Chris has said, our staff will have a range of views and opinions on this, as will the wider public. So the work you do in creating this Bill is really important in terms of the advice that we give to people about signposting and having those conversations. Actually, our clinicians are having conversations every single day about the choices that people have at the end of their lives.
Sojan Joseph (Ashford) (Lab)
Q
Professor Whitty: I would hope that most doctors are capable of identifying that someone has some degree—or a large degree—of mental health distress, or mental health illness, if you wish. What not all doctors will feel comfortable doing is actually deciding whether that is sufficient to interfere with someone’s ability to make a decision with full capacity. That is where help from colleagues from psychiatry, and mental health more widely, is going to be useful.
But that should be good medical practice, in my view, under all circumstances. This Bill takes it to a high level of need because of the seriousness of the decisions being taken, but that is part of medical practice. Duncan will have discussed with senior nurses, when he when he was operating clinically, “Should we actually get an opinion from a mental health colleague”—either a community psychiatric nurse, if it is that kind of question, a psychiatrist or others—“to make that assessment?”
That is really the question, but I certainly would not want to be in a situation where the fact that someone with a terminal diagnosis will have some degree of low mood in itself just rules them out from any kind of medical intervention—this, or any other. That should not be the case. They have to have access to whatever the state and the medical profession are able to provide—again, obviously, depending on what Parliament decides on this particular Bill.
Sojan Joseph
Q
Duncan Burton: I think you are absolutely right—anybody working in stressful environments. If the Bill is passed, we will need to make sure that we have sufficient psychological support for nurses and doctors working in these services, as we do now for many of our nurses and other professionals working in these kinds of situations. People working in end of life, or cancer nurses, for example, often have psychological support to help them deal with some very difficult conversations with patients.
We would need to look at that and make sure that sufficient support was in place for anybody working in these situations. We would also need to be mindful about the wider workforce, given the issues from such a debate as this and how the decisions to signpost people on to services might create—for some people—moral injury. We do need to think about the support in place for those people.
Jake Richards (Rother Valley) (Lab)
Q
Professor Whitty: It is entirely a matter for Parliament, at one level, but I can give a view. It goes back to the point that Naz Shah and others made earlier: the situations that people find themselves in are extraordinarily different—culturally, where they are in their lives, where their families are and a whole variety of other issues. Only the clinicians dealing with that person will really know all the different factors at play. If there is a good therapeutic relationship, and you would certainly hope there was, they should understand a whole variety of things that are very difficult for people sitting around this table to predict, however wise you are—although I am sure you are extraordinarily wise, to be clear. That was not my point. My point is that this is very difficult and I could not, at this point, write down a law that would be helpful to someone dealing with a whole range of different scenarios in which they are going to have to have an end-of-life discussion.
My own view, for what it is worth, is that I would do fewer things rather than more. That is partly because simplicity is the key to really good safeguards, in my experience. If the safeguards are really clear and simple, everybody understands them—if you ask six people, “What does this mean?”, those six will give you the same answer. The more complicated you make things, the more room there is for ambiguity and uncertainty—because different things are playing in—and the more difficult it is for the patient, their family and the medical and nursing professionals assisting them, to navigate the system.
Without in any sense wishing to curtail what Parliament might wish to do, I would make a plea for simplicity wherever possible and for accepting the extraordinary variety of people’s lives, which may have unpredictable consequences in terms of the way the end of their lives plays out.
Jake Richards
Q
Professor Whitty: I would certainly recommend that this is done by guidance or in secondary legislation, which can be adjusted if it turns out that it is not having the desired effect. Two things can change: first, we can spot things we had not thought of in the first place, however far-sighted each of us is. The second is that medicine itself changes, the diseases people suffer from change and so on.
An Act has to be durable and that is why I have my view about secondary legislation and guidance, which have the ability to adapt in a way that primary legislation cannot. The fundamentals obviously need to be in primary legislation, but these kinds of issues are often done better in secondary legislation.
The Chair
I am very mindful of the time, as it is now three minutes past 10. This will be the last question of the session.
Jack Abbott (Ipswich) (Lab/Co-op)
Q
“we must not undermine the provision of good end-of-life care for all including the outstanding work done by palliative care clinicians”.
Do we take it, by implication, that you are fearful that this Bill could undermine good end-of-life care? In your view, how might we mitigate some of those risks in the Bill?
Professor Whitty: I will give a view and then Duncan will be able, as chief nurse, to mention the parallel bit of advice that said similar things. I think all medical, nursing and health professionals very strongly believe that palliative care and pain alleviation, which is not the same as palliative care but overlaps with it, and end-of-life care, which is also not the same but overlaps with it, are essential, and in some areas are not to the high standard that we would hope for. That would be a common view across the medical profession.
My own view and hope is that the Bill should not make the situation either better or worse. It changes one particular aspect in a very important way, but it seems to me that on the principle that we should be improving end-of-life discussions, which is where end-of-life care starts from, as well as supporting further the alleviation of symptoms and the provision of palliative care, there would be no disagreement from anybody in the medical or nursing professions, any other professions or the general public. That must be fundamental to how the Bill is thought about—
The Chair
Order. That brings us to the end of our allocated time with these witnesses.
Professor Whitty: Duncan, do you want to say if you agree or disagree?
The Chair
Q
Duncan Burton: I absolutely agree with that. This is, obviously, a decision for Parliament, but it is clear that there is increasing discussion in society around death and dying, and I think that is important. It is important that we have discussions and support people with their choices at the end of life, so anything we can do to increase that is important.
The Chair
I thank our witnesses, Professor Chris Whitty and Duncan Burton, on behalf the Committee. I also thank Committee members for their short questions.
Examination of Witnesses
Mark Swindells and Dr Andrew Green gave evidence.
The Chair
Q
Mark Swindells: Good morning. I am here from the General Medical Council. The GMC, as the independent regulator of doctors across the UK, does not have a position on what the law should be on assisted dying. Similarly to what the chief medical officer said, we view it as a matter for wider society and, ultimately, Parliament. Having said that, we have looked at the Bill and, were it to pass, we would obviously be willing to work on things like the statutory code of conduct that it talks about to make sure the implementation works as well as possible.
Dr Green: Good morning. My name is Andrew Green. I am a retired GP, and I chair the medical ethics committee at the British Medical Association. We had a big survey of our members in 2020 and, on the basis of that survey, we moved from opposition to neutrality. All that means is that we neither support nor oppose any changes in legislation. That position has enabled us to reach out to people with a wide range of views and produce policy that we believe has broad support, looking particularly at the areas where it impacts on our members. We have had very positive engagement with legislators throughout the United Kingdom and the Crown dependencies, with the aim not of supporting the Bill, but of making sure that if it goes ahead, it works for doctors and patients. We have always believed that those things go hand in hand.
The Chair
Thank you very much. For broadcast purposes, can everyone make sure that they are as loud and clear as possible?
Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)
Q
“No registered medical practitioner is under any duty to raise the subject of provision”.
What are your views on the compatibility of that element of the Bill with the principles under Montgomery consent?
Dr Green: Both of these items came about because of things that were in our policy, and we are pleased to see them in the Bill. You are right that assisted dying must not become just another tick-box thing that doctors mention to patients. That must not happen, and that is why we believe that it should not fall within those two Supreme Court judgements that you mentioned. But there is another side to that coin: we think that there are some circumstances in which doctors should be able to mention this to their patients.
I will just explain why that might happen. The consultation shows that some patients find it very difficult to bring up sensitive subjects with their doctors, even when those are the most important thing on their mind. Doctors are aware of that, and I hope that we get very good at reading between the lines of what patients say to get at what is left unsaid. In those circumstances, we need to be able to open the door for the patient, so they can go into a safe space and have those difficult discussions. That is what we are talking about here.
As a clinician, it is very difficult to know when to have those conversations. When we are battling with that internally, the last thing we would want is to feel the weight of legislation behind us, so please do not pass legislation that makes it harder for doctors to understand their patients. That is why it is important that in particular circumstances we should be able to gently raise the subject.
Mark Swindells: The GMC sets guidance on decision making and consent, as you will know. That is based on the existing law, including the case law on Montgomery, so it puts a lot of weight on the patient’s autonomy, the patient’s role and the doctor’s role in supporting that in the provision of information on different options, including the option of no treatment. Our guidance follows the law, so were the law to change, we would look at it and accommodate. We do not have a formulated view on what the eligibility should be, but we know the BMA’s stance.
Dr Shastri-Hurst
Q
Mark Swindells: We have not done a forensic legal assessment of that nature, but obviously Montgomery is in case law, and Parliament has the power to set primary law. I listened to what the chief medical officer said and what Dr Green says about how restrictive or otherwise that might be in terms of the doctor’s role with the patient.
Jack Abbott
Q
Dr Green: Obviously, it would be great if we worked in a system where doctors had all the time they needed to deal with their patients. I believe that the Bill mentions a duty to provide information from the chief medical officer, and having read the Bill, to me it seems very much like this might be in the form of a website or leaflet. We believe that it is important that patients should be able to access personalised information, and we would like to see an official information service that patients could go to, either as a self-referral or as a recommendation from their GPs or other doctors. That would give them information not just about assisted dying, but about all the other things that bother people at this stage of their life, and it would mention social services support and palliative care. It could be like a navigation service as much as an information service. That might address some of your concerns.
Sean Woodcock (Banbury) (Lab)
Q
Dr Green: You are right: all medical staff have safeguarding training, and of course patients make important decisions often with the influence and help of their family members. Usually this influence is helpful, and it almost always comes from a position of love. The point at which such influence becomes coercion is difficult to find out, but my experience is that it is rare. I would recommend that you look at what has happened in other parts of the world that have more experience with this, because they have it as part of their training modules. Certainly, we would expect capacity and coercion training to be part of the specialised training that doctors who opt in would receive. I anticipate that the general safeguarding training should be sufficient for other doctors, who would obviously only be involved at that very early stage.
Kit Malthouse (North West Hampshire) (Con)
Q
As I understand it, the General Medical Council already has guidance on dealing with assisted dying if it is raised by a patient, and how doctors should handle that. How easy would it be to translate that guidance—the process struck me as something that does not hinder but also does not enable—into something more informative?
Mark Swindells: It is important to note that our guidance on assisted dying is framed in the current law, so it guides doctors to explain that it is not lawful for them to assist their patient to die. It talks about the importance of explaining other available treatment options, including palliative care; making sure that the patient’s needs are met; and dealing with any other safeguarding matters. Oure guidance does follow the law, so if the law were to change, we would obviously attend to that. It is not framed quite as you are suggesting, so I do not think that would lift and shift into what the guidance would need to be for doctors if this were to pass.
Dr Green: I do not have any experience with what you are describing, but it would certainly make sense to look at best practice in other areas.
Kit Malthouse
Q
Dr Green: As a general principle, I do not believe that unnecessary barriers should be put in the way of communication. This is such an important area for patients that it is vital that they form a good, trusting relationship with their key medical adviser, who would usually be a doctor. I also have to say that at the end of life, we depend a lot on our specialist nurses— Macmillan or Marie Curie nurses—and it might well be that they are the person whom the patient trusts most. Please do not put barriers in the way of understanding.
Kit Malthouse
Q
Dr Green: Indeed. I believe that in New Zealand—and I think in the state of Victoria, but I would need to check that—there have been official reviews that have identified those concerns, and they are looking to review the legislation.
Danny Kruger (East Wiltshire) (Con)
Q
I would like a quick clarification from Dr Green. In terms of the survey, my understanding is that the British Medical Association’s official position is to be neutral. The majority in favour of neutrality—moving away from an opposed position—were junior doctors and those not working with the elderly and the dying, whereas the great majority of doctors who work in palliative care and work with dying people remain firmly opposed to a change in the law. Is that your understanding?
Dr Green: There were some variations between specialities; that is true, but within all specialities, there was a wide variety of opinion. It is that wide variety of opinion that the BMA has based its policy on.
Danny Kruger
Q
I have a question for you, Dr Green, on the delivery of the service if it is brought into law. Is it your understanding that the Bill mandates the NHS to provide an assisted dying service? I appreciate that it is not clear in the Bill. Nevertheless, it does authorise the Government to pay for it and it establishes this right. My question to you is this: is this a medical procedure that we are proposing to legalise, and should the NHS provide it? If the answer is yes, should that be a separate service within the NHS or should it just be part of general practice?
Dr Green: We have not taken a view as to whether it should be inside or outside the NHS. That is not for us to take. We do believe that it should not be any part of any doctor’s normal job to provide assisted dying. In other words, it should be set up through a separate service with a degree of separation.
We believe that is important for patients, because it would reassure patients who may be anxious about the service that it would not just be part of their normal care. It would reassure patients that the service they were going into had proper quality and proper audit attached to it. It would reassure doctors, because doctors who did not want to have any part would not feel that it was part of their normal job, whereas the doctors who wanted to go ahead would be assured of having support, emotional support and proper training. Also, it should, hopefully, reassure the providers, who would then be assured that it would not be expected of them just as part of their normal duty. We believe a degree of separation is very important.
Danny Kruger
Q
Dr Green: I think we are always concerned about resourcing, and I can only back up what Dr Whitty said about the importance of palliative care.
Danny Kruger
Q
Mark Swindells: I would agree with you that there certainly needs to be really clear guidance for doctors on that scenario. We have not taken a view on whether that needs to be in the Bill, in regulation or in the statutory code of practice. What I would say is that we would be willing to participate in the setting of that. It would be very important to listen to the view of doctors and indeed patients who might be interested in taking such a course of action, to understand their issues.
Danny Kruger
Q
Mark Swindells: I am not trying to duck the question, but because we do not take a general view on whether the Bill should pass or not, we have not taken an established view on the delivery mechanism for it.
Lewis Atkinson
Q
Mark Swindells: We do get inquiries from doctors who are concerned that they are doing the right thing when it might become apparent to them that a patient wants to travel overseas to access assisted dying. We have taken legal advice, and on that basis, we guide doctors that it is permissible for them to provide the existing medical records to that patient, as you might under a subject access request, but to be really cautious about going any further in terms of recommending that or assisting the process more than that. That is based on our understanding of the existing law in the Suicide Act.
Dr Green: Of course, that leads to a further issue. As we heard from Dr Whitty today, this measure may progress at a different speed in Scotland and England and Wales. We also have the Crown dependencies, which are some way further ahead than the mainland Governments on it. That raises an issue for doctors who work in England and Wales but treat patients in the Crown dependencies. We would want clarity about the legal situation regarding a doctor in Liverpool who is treating a patient in the Isle of Man, should the law allow assisted dying in the Isle of Man.
Lewis Atkinson
Q
Dr Green: I do not think I ever suggested that doctors should recommend assisted dying. If I did, I apologise—
Lewis Atkinson
Sorry—I meant the provision of information for someone.
Dr Green: The provision of information would be very useful, because in a situation where a doctor was unwilling to have an initial discussion with the patient, it would provide a way for the patient to get that information that was in no way obstructive.
Lewis Atkinson
Q
Dr Green: We have not taken an official view on doctors recommending it, but I do not think it was ever in any of our minds that doctors would be recommending it as a course of action to patients.
Lewis Atkinson
Q
Dr Green: I am reluctant to make a statement on that in this forum. We will go away and discuss it, and come back to you.
Naz Shah
Q
The question that worries me is, to be able to fulfil all those actions in all cases, without fear of mis-determining, the two doctors would have to be specialists in all the relevant diseases. For example, if somebody has a brain tumour, lung cancer, or a different type of cancer, would the doctor have to be an expert in that to determine that the person is terminally ill?
From the GMC’s point of view, would we find ourselves in a situation where doctors are working outside their professional competencies and expertise? From the BMA’s point of view, how do we protect doctors from finding themselves having to diagnose life expectancy for a disease they are not a specialist in, or to determine capacity when they are not a specialist in that, or to determine a lack of coercion when they potentially do not know the patient and do not have experience of that? Finally, when the next step is taken and the court has to rely on the testimony of these doctors to protect the patient, can those testimonies safely be relied on by a court and by a judge, given all those concerns?
Mark Swindells: There are quite a few points there—let me work through them backwards. We have some existing guidance for doctors when they act as a witness—for example, in a court setting or a medical legal situation—that talks in general terms about the importance of being an appropriate witness. Inherent to that is some expertise and understanding of the topic they are assisting the court on. I suppose that those sorts of principles would be ones that, if the Bill is passed in this form—I say again, the GMC does not have a view on what the delivery mechanism or the Bill should look like—are applicable points from the guidance, which would read across.
You heard from the chief medical officer his caution with regards to going with a condition-based assessment for this sort of thing. We would not have a particular view on that, but there is one thing that I want to highlight. The Bill talks about specialism in the context and seeking advice from a psychiatrist. On the specialist register held by the GMC, there are five specialisms connected with psychiatry, so some clarity—whether the Bill is intended to cover any, or a particular one, of those—would be good.
I know that it is not restricted in the “independent doctor” and “coordinating doctor” roles in the Bill either, but we are aware that when doctors pursue a specialty, in the sense that they become accredited and go on to our specialist register, that does not fix in time their individual scope of practice or expertise. Many doctors will go into slightly different fields, or focus on one particular area, so one cannot necessarily rely on the specialist register as a current indication of a doctor’s area of competence in that way. On what the precise delivery mechanism is and the point you make about whether either of those two roles of doctor have seen the person, because we have not taken a view on what the law should be, we have not taken a firm view of any process or eligibility, but I note the point.
Dr Green: If I may, I will clarify my previous answer, having had a little more thought. I do not believe that it is ever appropriate for a doctor to recommend that a patient goes through an assisted dying process. My internal thoughts on whether it should be on the face of the Bill, contained in guidance or contained in good medical practice was the point that I was unsure about.
Lewis Atkinson
indicated assent.
Dr Green: With regard to the specific questions, no, I do not believe that a doctor has to be a specialist in the individual disease at stake to advise a patient about prognosis. I can only refer you back to what Dr Whitty said: that in the majority of cases, it is fairly clear—this applies to capacity, too—but in some cases, it is not so clear. What is important is that the doctor has the ability to seek further advice if they need it; it is not always required.
Dr Opher
Q
“registered medical practitioner who is unwilling”
to go forward with the assisted dying request
“must, if requested…refer…to another registered medical practitioner”.
Are you happy with that clause?
Dr Green: No, we are not, because we know from our survey that some doctors feel very strongly about this. The word “referral”, to a doctor, means writing a letter or communicating with another doctor to see, but some doctors would find themselves not able to do that. For that reason, we believe that there should be an information service for the doctor to direct to. There is a particular problem with the word “referral”. Doctors would not be able to be obstructive; they have the same duties under good medical practice as they do, for example, with termination of pregnancy requests.
Dr Opher
Q
Dr Green: We have not taken a view on the qualifications of the doctors involved. We had discussions about what grade they should be, for example, but we took the view that their skillset and training was more important than their grade or position.
Dr Opher
Q
Dr Green: We did not take a view on that. We thought that training and experience was more important.
Sarah Olney
Q
Dr Green: That is why it is important that doctors should be able to opt out at any stage of this. There are doctors who would find it difficult to do that, and it is important that their position is respected.
Kim Leadbeater
Q
Dr Green: What would happen is that the doctor would provide the patient—through their receptionist, through leaflets or through a telephone number—with somewhere they could get the information. You cannot just abandon a patient. They have to be sure that the patient has the ability to do what the patient wants to do.
Kim Leadbeater
Q
Dr Green: Yes. It is the “referral” word that is problematic for us.
Kim Leadbeater
Q
“respect competent patients’ right to make decisions about their care, including their right to refuse treatment, even if this will lead to their death”.
I am interested in how that fits in with those very difficult conversations. When a patient executes that right to refuse treatment, are those cases logged? Are they monitored or reported on?
Mark Swindells: There was an important piece of case law—I think in the 1990s—that clarified that a patient refusing treatment and subsequently dying is not an act of suicide. You are right that our guidance talks about the importance of a doctor explaining to the patient about the likely course of action in terms of the option for no treatment. Again, that is intertwined with the Mental Capacity Act 2005, and puts a lot of autonomy in the space of the patient, along with the consent case law that we covered before.
On the previous point about referrals, our guidance is similar to what Dr Green was saying: in the case of conscientious objection—for example, on abortion—the important point is that, from the patient perspective, they are not left with nowhere to go. If that assists, that may be a principle that helps and reads across.
Kim Leadbeater
Q
Mark Swindells: Yes. It would be important for the patient’s records to cover the points of consent and that the doctor has recorded that they have interacted with the patient that way. I do not believe it is centrally held or collated in any sense like that, but I may be wrong.
Jake Richards
Q
Dr Green: Yes, with the exception of the referral.
Jake Richards
Thank you. I just wanted to clarify that.
Dr Green: Of course, we would regard much of clause 4(4) as normal care in any case.
Jake Richards
Q
Dr Green: As Dr Whitty said, I think simplicity is the key here.
Liz Saville Roberts
Q
Dr Green: In terms of the cross-border issues?
Liz Saville Roberts
Yes.
Dr Green: I think the concerns are that patients, particularly those from the Crown dependencies, might be looking for some things—for example, report on life expectancy—from doctors on the mainland. I think it is clear that if a doctor travelled to the Isle of Man or Jersey to do the work there, the GMC would be happy for them to do so, but we would want a clear understanding that they would not be at risk of any other legislative problems—from the DPP, for example.
Liz Saville Roberts
And of course legislation is progressing in Scotland, which has different definitions from the legislation that we are discussing here.
Dr Green: Correct.
Liz Saville Roberts
Q
Mark Swindells: There are aspects in which the law will differ, including on capacity. As a UK-wide regulator, we have managed to attend to that in our guidance, so that doctors are as clear on their responsibilities as possible when they lie either side of a devolved border. There is a nuanced point with the Crown dependencies. In law, we are a UK-wide regulator, and we know that the Crown dependencies and Gibraltar will choose to use doctors who are on the GMC register. Officially, we do not legally cover those areas, but it does give us some regulatory purchase there. If a doctor wishes to remain licensed to practice on the GMC register, there is a commitment to follow our professional standards.
Sojan Joseph
Q
Mark Swindells: We do not hold data. I have seen the coverage of the Bill and the uncertainty. I think we would agree with a lot of what the chief medical officer said to you about the stepped decision that a doctor will make, depending on the importance of the situation. We try to capture that in our end-of-life care guidance. We also agree with the point about a doctor giving a central estimate. In the guidance we talk about, for example, issues with taking a second opinion where there is a greater degree of uncertainty, and the importance of doctors keeping up with the latest clinical knowledge on the efficacy of different treatment courses to come to that determination. We would agree that there is inevitably a degree of uncertainty in the central ground that the chief medical officer was talking about.
Kit Malthouse
Q
Mark Swindells: I do not believe that we use the word “refer”, but I will double-check. The word “referral”—this is part of the BMA’s position—has a particular meaning in the world of medicine. We talk about the importance, from a patient perspective, of not being left with nowhere to go, so there is some professional responsibility on the doctor to guide.
Kit Malthouse
Q
Dr Green: We would expect that to be done with sensitivity.
The Chair
Order. We have come to an end, but you may complete your sentence, Dr Green.
Dr Green: That was my complete sentence.
The Chair
Excellent. That was perfectly timed.
That brings this session to a close. On behalf of the Committee, I thank the witnesses: Mark Swindells, assistant director of standards and guidance at the General Medical Council, and Dr Andrew Green, chair of the medical ethics committee at the British Medical Association.
Examination of Witnesses
Glyn Berry and Professor Nicola Ranger gave evidence.
The Chair
We will now hear oral evidence from Glyn Berry, via Zoom—hello and welcome—and from Professor Nicola Ranger. We have until 11.25 am. Will the witnesses please introduce themselves?
Glyn Berry: Good morning. My name is Glyn Berry. I am a palliative care social worker and a lead allied health professional. I am co-chair of the Association of Palliative Care Social Workers.
Professor Ranger: I am Professor Nicola Ranger, chief exec and general secretary of the Royal College of Nursing. Previously, I was a chief nurse in acute hospitals for 10 years.
Rebecca Paul
Q
“There is a risk that without a more sustainable model of funding for palliative care, many people will choose an assisted death, as the only way to escape from unbearable suffering.”
Can you elaborate on why you say that?
Glyn Berry: Yes. As experienced social workers, working within the realms of a society that is quite often split into “have” and “not have”, we already see the despair and the difficulties that people encounter with inequitable care in palliative care services. We know that a lot of services are delivered by charities as well as statutory agencies and the trusts, and we know that the funding for palliative and end-of-life care is a real issue and has been heading that way for some years.
We would hate to see what has been happening in other countries in which assisted dying is already in place, where people feel that they have no option other than to apply for assisted dying, because they do not know what else might be out there for them. That is the role of a social worker when we work with our patients: we look at the bigger picture, not just at what is happening clinically. Obviously we depend hugely on our clinical colleagues and expertise, but our specialism, if you like, is to look at what else is out there for a patient—and for their family and friends, because they are as much a part of the patient’s journey as the patient themselves.
We also know that palliative and end-of-life care is hit and miss in terms of what people can access. Marie Curie reporting in 2024 showed that there are massive disparities in terms of better care for people at end of life or with a palliative condition, and they have a significant effect. What we say to people is that we will help them to live as long as they can as well as they can in palliative and end-of-life care situations, but that is really difficult when the resources are not there and things become a huge priority.
Rebecca Paul
Q
The Chair
Order. We are going slightly off topic, so could we have a brief answer?
Glyn Berry: It would be something that is equitable for everybody. At this moment in time, it is not. As I say, some people get it and some people do not. A sustainable model would give fair access to everybody.
Tom Gordon (Harrogate and Knaresborough) (LD)
Q
Glyn Berry: We work very closely with clinicians and other health professionals. We talk about a multidisciplinary approach, because a person is not just two-dimensional; everything about their life needs the input of others in these situations. As social workers, our expertise and strength is in being able to ask difficult questions and really dig into people’s thoughts, feelings and opinions, giving them an opportunity to say things that sometimes they have never said in a whole lifetime. Other areas are around assessing capacity and giving people the option of knowing that there is not just one way of doing things.
I have worked in a hospice setting for the last six or seven years. I see daily how social workers contribute to the wider MD team in terms of safeguarding, capacity and applications for deprivation of liberty, but we also do the psychosocial aspect of palliative and end-of-life care. We sit and talk with patients, we do advance care planning and we deal with practical aspects such as supporting the arrangement of funerals. For families in which the parent or primary caregiver is the person who is ill, we will work with external statutory agencies like local authorities to give support where there may be children or vulnerable adults who are being cared for by the patient, to have provision put in place for after the death of the person. We also provide pre-bereavement support for both the patient and the family, and post-bereavement support for the family.
We have quite an extensive skills catalogue to support patients and families, but one of our biggest skills we have is in communication and in not being afraid to go where other professionals may feel uncomfortable going. Having conversations about people wishing to end their life is not a new thing: we have those conversations quite regularly.
Tom Gordon
Q
Glyn Berry: In our association, we have a list of recommendations. We are very conscious that the Bill is very heavy from a clinical perspective. There are a number of things. We do not feel that the decision and assessment should be all on the shoulders of a health professional, the clinician. Some clinicians are fantastic with assessing capacity and being aware of the safeguarding aspects of situations, but not all are, and we feel that our expertise lies in that particular area.
When we look at the overview of the process set out in the Bill, it is very, very clinical. Nowhere does it talk about the clinician exploring the other aspects of a person’s life; it is very much around the clinical aspect, and quite rightly so, because these are experienced clinicians. We feel that we should be involved in these decisions from the capacity and safeguarding aspect, but also in seeing whether there are things we can do to help the person make a more informed choice. If their decision to take their life is based on the fact that they do not have secure housing, that their benefits or finances are all over the place, that they do not want to be a burden on their friends or family, or indeed that they have nobody at all, those are areas that are very familiar to us in our daily practice. We therefore feel that we are well placed to support the clinicians in the whole process.
Tom Gordon
That was a really comprehensive answer. I think the key point that you touched on is the multidisciplinary approach.
Juliet Campbell (Broxtowe) (Lab)
Q
Professor Ranger: I think there is something really important about having a big difference in the beginning with regard to palliative care and assisted dying, and pain management. It is essential that those two things are slightly separated, because it would be heartbreaking to think that pain management was the primary reason that someone wanted to be assisted to die. We should be able to control and support someone’s symptoms and pain.
I think the primary thing with regard to being referred to another organisation is autonomy. I absolutely agree with what was said earlier: you would want anyone who is considering assisted dying to be slightly separated out of their normal clinical pathway, so it is not part of mainstream care for someone in a hospital or an organisation. There is something really important about separating that out, both in the discussions around the decision making and in any care involved in assisting them to die. I think those two things do need to be separated.
Juliet Campbell
Q
Professor Ranger: Well, you would not really want any clinician to push this view on any patient. It has to come from the person themselves. That is the key thing around capacity and autonomy. I do not think that people should ever say to a patient or an individual, “Is this something you have considered?” It has to be led by the patient.
Dr Marie Tidball (Penistone and Stocksbridge) (Lab)
Q
Professor Ranger: It is vital that any of those barriers be removed and that we always maintain outstanding care at the end of someone’s life. The reality is that the majority of palliative care is given by nursing staff, whether it is in the community, in someone’s home, in a hospice or in a hospital. It is key that it be an expertise and a specialist practice in which someone has extra training and extra education. The skills of listening to patients, advocating for them and ensuring that they are pain-free at the end of their life—these are skills that nurses have now, and it is vital that our nursing members maintain them. They are often the one a patient will speak to at 3 in the morning when no one is there.
As Glyn said, it is vital that the wider team be included in the Bill. The Bill talks about the guidance and recommendations being for the chief medical officer, but I think it is absolutely vital that the chief nursing officer be a key part of the guidance and the drawing up of any care, because even in these circumstances it is nursing staff who will give the majority of the care.
Dr Tidball
Q
Professor Ranger: Safeguarding is part of our professional responsibility now. Whether it is for a child, an adult or an elderly person, part of our role is to be vigilant against financial misconduct, physical abuse and mental health abuse: any of those things is a responsibility of every nurse now. It is a very good and simple process. You do not have to investigate or give a judgment; you need to refer it to be investigated. That takes the pressure off an individual clinician. Our job is to be vigilant and to refer safeguarding anywhere we think that there is any form of abuse. I think that that process would remain and could be part of how we do things now.
Dr Tidball
Q
Professor Ranger: We would want more support. I am not going to say that we always get it right. Sometimes things happen that we miss and we do not report. I cannot say that we get it right 100% of the time. When the Bill talks about education and training for medical staff, it is absolutely vital that nursing staff are included because we will need to be vigilant around anyone feeling they are a burden.
The Bill would add other skills that we want to make sure that nurses are included in. Education for medical staff is absolutely pertinent for nursing staff, so that nurses build on skills they already have. There will be a difference between the care of someone wanting assisted dying and palliative care. Those are two slightly different skills and it is really important that they are not always lumped together. Being involved in assisted dying will require a specialist skill and specialist training, and we would very much want nursing to be included within that.
Dr Tidball
Q
Professor Ranger: I do. They are professionals, and I believe they would be able to.
Jack Abbott
Q
Secondly, what level of training would that person need in terms of time? We have, for example, been talking about a two-year process. If this new role came into effect, how long would that person need to be trained for to fulfil it adequately? Thirdly, do you have a sense of how many of these professionals we would need to make this a functioning system? Those are three separate questions.
Glyn Berry: To answer the first question, we feel, for the reasons I outlined earlier, that the role of an approved palliative care professional would sit beside the role of clinicians, balancing clinical and social observation and assessment.
In terms of the training, we, as social workers, already have continuous training opportunities to become best interests assessors, practice educators and approved mental health practitioners, so we envisage that the training would very much be along those lines. Doing those roles currently requires a course of training at university.
Our thoughts, at the moment, are that that would be for palliative care social workers, whether they are in charities, trusts or local authorities, or are independent, because that is where things sit with us at the moment and we know our roles. We like to think that it would roll out to other professionals, however, because assessing capacity is not specifically the role of the social worker; other professionals are able to, and do, complete capacity assessments.
It is quite difficult to answer your question in terms of numbers at the moment. If we were talking specifically about palliative care social workers, we currently have around 200 members in our association, but there will be other people out there who are not members and we do not know who they are. It is a role that could expand.
One of our other recommendations is that palliative and end-of-life care, as an aside to your question, is also brought into qualifying roles for people in training, such as doctors, nurses and allied health professionals, as well as social workers. We could see that happening in the future.
Kim Leadbeater
Q
I want to ask a bit more about what this end-of-life conversation looks like in your experience, because you are absolutely right; of all the people who are spending time with patients in their last few months of life, it is often nurses and palliative care social workers. You have a really important role to play.
I am also interested in what this would look like in reality. There has been talk of a kind of separation of palliative care and assisted dying, but, actually, I think we should be looking to embrace a holistic approach to end-of-life conversations and end-of-life care, which is what has happened in other jurisdictions. You might have a patient who has signed up for assisted dying but never does it because they have good palliative care and they work with their palliative care experts and specialists. Therefore, I think it is important that we do not try to separate these things.
I would like your views on that, but I think that one of the strengths is that having these conversations about death, about dying and about end of life is a really positive thing. Your members have an important role to play in that, so could you talk a little bit about the holistic approach that your members take?
Professor Ranger: You are right regarding the conversations and the care around dying. Having those conversations with people around pain management and symptom management is particularly the role of palliative care nurses. With assisted dying, I think the conversation is sometimes slightly different. It is talking more as a nurse in some ways, because the primary reason that assisted dying is often a discussion is a lack of autonomy, not pain. Therefore, the conversation generally tends to go in a slightly different way.
Symptom control, and being scared of pain, is understandable, and we absolutely have the ability to get that right for people, but when it comes to seeking assisted dying, the primary reason is usually autonomy, rather than pain and fear of dying. Therefore, in a practical way, I think an experienced nurse or doctor will start to gauge the difference in those conversations, because they are different. I think it is about being really clear around those conversations and really listening to what people have to say, and then having a way to be able to ensure that what an individual wants is something that you have got, and that you listen to.
I absolutely agree with Glyn about safeguards and all the things that we absolutely need to make sure are there, but the whole point of assisted dying is not to be paternalistic, but to respect autonomy. Whatever safeguards we put in with that, we have to be really careful not to ignore that right of autonomy, which is primarily what this Bill is trying to preserve.
I think it is about being really vigilant and listening. A primary role of a nurse is not to advocate their personal view, but to really listen to somebody else and to ensure that what they want is pursued. In all that discussion, it is really important that that does not get lost.
Kim Leadbeater
Q
Kim Leadbeater
Yes. It sounds as though you are saying that your professionals are trained to have those conversations, which is very reassuring. Glyn, do you want to add anything?
Glyn Berry: Just to say that I absolutely agree with Professor Ranger. My experience of working with palliative nurses, and nurses in general, is long, and I have historically had exceptionally positive experiences and continue to do so. I think that we learn from each other, and it is really important that we can have those conversations with the person and ask questions that they might never have been asked before, such as, “What is it that you want?”
Professor Ranger is absolutely right in terms of autonomy and the person having control, because once that diagnosis is given, it can be a downward spiral for a person and they feel that they lose control. Patients and families talk about that—about having no control over what is happening. In effect, that is true in terms of what is happening in the disease or illness trajectory, but it is so important to remind a person that they are still the person that they were before that diagnosis, that they will continue to be that person, and that they still have a voice. In both our roles professionally, and alongside other clinicians, that is what we seek to do all the time. That is why a multidisciplinary team approach is so important.
Ultimately, we could find that, once you have asked all the appropriate questions and you have put potential safeguards in place following conversations, a person may not choose that particular point to end their life—as you mentioned, Kim—and may continue to live to the end of their natural life.
Sojan Joseph
Q
Professor Ranger: Yes, we would want to see more support and protection for nurses. Of course, in the exploring of assisted dying legislation in Scotland, the second clinical decision maker is a nurse—so it a doctor and a nurse, whereas in England and Wales we are looking at two medically qualified practitioners. We absolutely want to make sure that the skills and support is there for nursing staff, and the ability—as I heard our medical colleagues saying—to not be involved in assisted dying absolutely has to be supported. It cannot be an expectation of the role; it has to be something you choose to proactively take part in as a conscious decision. It cannot ever be just an expectation of a nurse. We are absolutely adamant about that. The Bill cannot just support the needs of medical staff—nursing absolutely has to be included within that, both in skills and support.
Kit Malthouse
Q
Professor Ranger: It is difficult. If I am honest, we have probably not explored that enough within our thinking as a college. We know what we would not want to see, which is a situation where there is an expectation that it becomes part of a pathway. It has got to be something you actively seek and opt into. I think how that is administered probably requires more thought, if I am honest, but I would not want to see it becoming an expectation of a pathway, because then the pressure on the individual may change. That is something we need to safeguard against.
I am worried that we should not make it so bureaucratic for the individual that it becomes impossible to have their autonomy respected, but how that happens is something that needs further exploration. We would fully support making it as clear and unbureaucratic for the person as humanly possible. But we would not want to see it as a sort of pathway within our current setting, because there could then be a sense that this is something that is externally influenced rather than being something that someone actively seeks for their autonomy.
Danny Kruger
Q
Professor Ranger: It is difficult, but in my experience there are ways to try and get people palliative care, whether that is, as was said earlier, via other organisations outside the NHS and within hospice care. There are ways through the current routes to get people the care that they need.
Danny Kruger
Q
Professor Ranger: I do not think it is as good as it needs to be. We know that it is sometimes hard for people to access care. We know the struggles regarding hospices. We know far too many people die in hospital. We know there are real challenges in social care and the health service. I cannot say it is not without challenge.
Danny Kruger
Q
Professor Ranger: When you put it like that, it could be possible, but we would want to strive to have a system that does not leave anyone in distress.
Danny Kruger
Q
Do you think—I cannot decide for myself what the answer is—it should be possible for a care home director to exempt their whole service, that care home and the people who work in that care home, from being involved in assisted dying? That is where people live, after all. If somebody is having it there, it could affect the entire atmosphere of the place, and the work that all of the people there have to do. Do you think they should be protected as an organisation?
Professor Ranger: Particularly for nursing homes, I think that would be difficult. How and where people end their life probably needs further thought and further explanation. There is something about being really clear— if you are the leader of that nursing home, we would have to explore your ability to be able to advocate for the care that you want to be able to give in that nursing home. All of these practical things need further exploration.
It is difficult, because for someone who wants to end their life, if that is their home, they may want to be there. It is all of these practical things that probably need further thought and exploration, because I think it could be argued either way.
The Chair
Q
Glyn Berry: I do not think so. I think that the last question around care homes was a really good one. I am already thinking about the implications for registrations with the Care Quality Commission and what that would mean in terms of the process and the protection of staff, residents and families. It is a really helpful question to think about.
The Chair
That brings us to the end of the time allocated for the Committee to ask any questions. I thank our witnesses on behalf of the Committee, Glyn Berry, co-chair of the Association of Palliative Care Social Workers, who appeared via Zoom, and Professor Nicola Ranger, chief executive and general secretary of the Royal College of Nursing. Thank you all very much indeed.
Finance Bill (First sitting)
Tuesday 28th January 2025
(2 days, 18 hours ago)
Public Bill CommitteesRead Full debate Finance Bill 2024-26 View all Finance Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 January 2025 - (28 Jan 2025)
The Committee divided: - Ayes: 10 / Noes: 4 - Question accordingly agreed to.
The Chair
Will everyone please ensure that all electronic devices are turned off or switched to silent mode? Tea and coffee are not allowed in the Public Bill Committee.
We are here today for line-by-line consideration of the Finance Bill. The selection list for today’s sitting is available in the room and on the parliamentary website. It shows how the clauses, schedules and selected amendments have been grouped together for debate. A Member who has put their name to the lead amendment in a group is called first. In the case of a Government amendment or stand part debate, the Minister will be called to speak first. Other Members are then free to indicate that they wish to speak in the debate by bobbing.
At the end of the debate on a group of amendments, new clauses and schedules, I shall call the Member who moved the lead amendment or new clause again. Before they sit down, they will need to indicate whether they wish to withdraw it or to seek a decision. If any Member wishes to press to a vote any other amendment in a group, including grouped new clauses and new schedules, they need to let me know.
Ordered,
That—
1. the Committee shall (in addition to its first meeting at 9.25 am on Tuesday 28 January) meet—
(a) at 2.00 pm on Tuesday 28 January;
(b) at 11:30 am and 2.00 pm on Thursday 30 January;
(c) at 9.25 am and 2.00 pm on Tuesday 4 February;
2. the proceedings shall be taken in the following order: Clauses 1 to 6; Clauses 13 and 14; Clause 19; Schedule 4; Clauses 20 to 25; Schedule 5; Clauses 26 to 31; Schedule 6; Clauses 32 to 35; Schedule 7; Clauses 36 to 38; Schedule 8; Clauses 39 and 40; Schedule 9; Clause 41; Schedule 10; Clause 42; Schedule 11; Clause 43; Schedule 12; Clauses 44 to 46; Schedule 13; Clauses 54 to 86; any new Clauses or new Schedules relating to the subject matter of those Clauses or those Schedules; remaining proceedings on the Bill.—(James Murray.)
Resolved,
That, subject to the discretion of the Chair, any written evidence received by the Committee shall be reported to the House for publication.—(James Murray.)
The Chair
Copies of the written evidence that the Committee receives will be made available in the Committee Room.
I remind Members about the rules on declarations of interest as set out in the code of conduct. Does any Member wish to declare any interests? No. Then let us begin.
Clause 1
Income tax charge for tax year 2025-26
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Clauses 2 to 4 stand part.
New clause 3.
The Exchequer Secretary to the Treasury (James Murray)
It is a pleasure to serve on the Committee with you as the Chair, Mr Mundell. Clauses 1 to 3 impose a charge to and set the rates of income tax for 2025-26, and clause 4 maintains the starting rate for savings limit at its current level of £5,000 for the ’25-26 tax year.
Income tax is the largest source of Government revenue and helps to fund the UK’s schools, hospitals and defence, and other public services that we all rely on. In ’25-26, it is expected to raise around £329 billion. The starting rate for savings applies to the taxable savings income of individuals with low earned incomes of less than £17,570, allowing them to benefit from up to £5,000 of income from savings interest before they pay tax. It specifically supports those taxpayers with low levels of earned income.
As Committee members will be aware, both the income tax rates and the starting rate limits for savings must be legislated for each year. The Bill will not change the rates of income tax. We are confirming that they will remain the same, thereby meeting our manifesto commitment not to increase the basic, higher or additional rates of income tax.
Clause 1 imposes a charge to income tax for the year ’25-26. Clause 2 sets the main rates of income tax, namely the basic rate of 20%, the higher rate of 40% and the additional rate of 45%. These will apply to non-savings, non-dividend income of taxpayers in England and Northern Ireland. Income rates in Scotland and Wales are set by their respective Parliaments.
Clause 3 sets the default rates at the same levels as the main rates, namely 20%, 40% and 45%. These rates apply to the non-savings, non-dividend income of taxpayers who are not subject to the main rates of income tax, Welsh rates of income tax or Scottish rates of income tax. For example, they might apply to non-UK-resident individuals. The clause also sets the savings rates of income tax—again at 20%, 40% and 45%.
Clause 4 will maintain the starting rate limit at its current level of £5,000 for the ’25-26 tax year. The limit is being held at this level to ensure fairness in the tax system while maintaining a generous tax relief. In addition to the starting rate for savings, whereby eligible individuals can earn up to £5,000 in savings income free of tax, savers are also supported by the personal savings allowance, which provides up to £1,000 of tax-free savings income for basic rate taxpayers. Savers can also continue to benefit from the annual individual savings account allowance of £20,000. Taken together, as a result of these generous measures, around 85% of savers will pay no tax on their savings income.
Finally, I should mention the Government’s efforts to encourage those on the lowest incomes to save through the help to save scheme. We recently extended the scheme until 5 April 2027, and we have extended the eligibility to all universal credit claimants who are in work from 6 April 2025. I encourage Committee members to do what they can to promote the scheme to their constituents.
New clause 3 would require a review of how many people who receive the new state pension at the full rate are liable to pay income tax this year and in the next four tax years, and specifically what the tax liability of their state pension income will be. The Government consider the new clause to be unnecessary, given the information that is already publicly available.
His Majesty’s Revenue and Customs has published statistics for this tax year and past tax years that cover the number of income taxpayers, including breakdowns by marginal rate, tax, band and age, and the Department for Work and Pensions has published figures for pensioners’ average incomes. The Office for Budget Responsibility is the Government’s independent economic forecaster and most recently published projections of the number of income taxpayers for future years in its “Economic and fiscal outlook” at autumn Budget. Those projections include a breakdown by marginal rate.
Income tax is a vital revenue stream for our public services and the clauses will ensure that that remains the case in 2025-26, while also retaining the starting rate of savings at its very generous existing value. I therefore commend clauses 1 to 4 to the Committee, and I urge the Committee to reject new clause 3.
Gareth Davies (Grantham and Bourne) (Con)
It is a great pleasure to see you in the Chair, Mr Mundell. This is one of many Finance Bill Committees that I have participated in. The subjects have changed somewhat each time, but something has remained consistent: the presence of the hon. Member for Ealing North. It is a pleasure to see him in his place, and I hope that his experience as the Treasury Minister in a Finance Bill Committee is as unpleasurable as mine when I was facing him.
As the Minister rightly set out, clause 1 imposes a charge to income tax for the year 2025-26, which is a formality. Clause 2 sets the main rates of income tax in England and Northern Ireland for 2025-26—the 20% basic rate, the 40% higher rate and the 45% additional rate—leaving them unchanged. Clause 3 sets the default rate and savings rate of income tax for the tax year 2025-26 for the whole of the United Kingdom. Clause 4 freezes the starting rate limit for savings at £5,000.
Of course, the Government’s big announcement on income tax in the Budget was that they would not extend the freeze to income tax thresholds beyond April 2028. Committee members will be aware that that announcement does not need to be legislated for, as the income tax personal allowance and the basic rate limit are subject to consumer prices index indexation by default, unless Parliament overrides that via a Finance Bill, and Parliament has not overridden indexation beyond the 2027-28 tax year.
As the current legislative framework did not allow the Government to enact their announcement on income tax thresholds at the Budget, we must take them at their word that they will keep their promise and not succumb to the temptation to override the thresholds in future. Given the possibility that rising borrowing costs have eliminated the Chancellor’s headroom under the Government’s own stability rule, I would be grateful if the Minister could reconfirm that they will allow CPI indexation to resume from 2028-29 and that they will not renege on that promise.
On a point of clarity, I would be grateful if the Minister could confirm whether the unfreezing of income tax thresholds in 2028-29 will involve an increase to the fixed portion of the income tax higher limit, which he will be aware of. The limit is set at £100,000 plus twice the personal allowance, and that £100,000 is not indexed to CPI by default. Should we expect the additional rate to rise only in so far as the personal allowance rises, or will that £100,000 be unfrozen too? I would appreciate an explanation on that.
I leave it to others to interpret what it says about this Labour Government and Budget that a non-binding commitment merely not to raise some tax thresholds in three years’ time is presented as a big win for the British taxpayer. On income tax, as with most of the Government’s more positive policy announcements, the benefits are prospective and entirely speculative.
Meanwhile the pain, as we have seen with national insurance contributions and in other areas, is very much immediate and certain. Pensioners left out in the cold by the Government this winter will recognise that all too familiar pattern. A pensioner who receives the full rate of the new state pension without additional income—whose income from April is roughly £12,000—is now in most cases no longer receiving the winter fuel payment. The Government have defended that decision by referring to the triple lock.
Will the Minister update the Committee on when the Government now project the full rate of the new state pension to exceed the income tax personal allowance, and how many pensioners they expect will be newly taken into income tax as a result of the development? If he cannot tell the Committee, perhaps he and his colleagues will vote in favour of new clause 3, which would require the Treasury to produce and publish forward projections for the number of people receiving the full rate of the new state pension who are liable to pay income tax, and specifically what the tax liability of their state pension income will be.
Pensioners cannot easily alter their financial circumstances, yet they were given less than six months’ notice of the withdrawal of the winter fuel allowance. They must not be blindsided for a second time by the taxman—especially not those who are just about getting by without additional income beyond the state pension. I urge Members and the Minister to vote for new clause 3 to prevent that from happening.
James Murray
I thank the shadow Minister for the comments at the beginning of his speech, if not for all the questions subsequently. First, on the question about whether the £100,000 threshold will be unfrozen in due course, that threshold does not move, and it sets the personal allowance taper beyond that level.
The shadow Minister asked broader questions about the personal allowance and our decision to change the policy we inherited from the previous Government. In the many Finance Bill Committees that he and I served on before the general election, the personal allowance would routinely be frozen for more and more years into the future. That is what we have inherited: the personal allowance is frozen up until April 2028. We made clear that we would do things differently. As well as not increasing the basic higher and additional rates of income tax, as we set out, we did not freeze the personal allowance beyond April 2028, which means that it will continue to rise with inflation.
The shadow Minister asked specific questions about how the change affects pensioners, and referred to new clause 3, which I addressed earlier. I will repeat what I said: new clause 3 is not necessary because the data the shadow Minister requests is already in the public domain. We need to ensure that as the personal allowance begins to rise from April 2028, that will benefit not just people in work but pensioners, because they will see the personal allowance that applies to their pension income rising as well. That is underlined by the fact that we are maintaining the triple lock, which will see generous increases in the state pension as the bedrock of state support for pensioners.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clauses 2 to 4 ordered to stand part of the Bill.
Clause 5
Appropriate percentage for cars: tax year 2028-29
Question proposed, That the clause stand part of the Bill.
James Murray
Clauses 5 and 6 make changes to ensure long-term certainty on company car tax by setting the rates for 2028-29 and 2029-30. The increases in the appropriate percentages will help to ensure that the tax system contributes to supporting the sustainability of the public finances. The effect of the clauses is to gradually narrow the differential between zero emission and electric vehicles and their petrol and diesel counterparts, while ensuring that significant incentives to support the take-up of EVs remain in place. The provisions also increase rates for hybrid vehicles.
Company car tax applies when a company car is made available to an employee or their family member for private use. Company car tax rates were confirmed by the previous Government up until 2027-28. In the 2024 autumn Budget, the Government set out the rates for 2028-29 and 2029-30, to provide certainty.
The Government recognise that the company car tax regime continues to play an important role in the EV transition by supporting the take-up of EVs and their entry into the second-hand car market. Although it is important to maintain strong incentives to encourage the take-up of EVs, the Government need to balance that against the responsible management of the public finances by gradually withdrawing them over time, as EVs become more normalised. That is why we have committed to raising the company car tax rates—or appropriate percentages—for EVs, hybrids, and petrol and diesel vehicles in 2028-29 and 2029-30, gradually narrowing the differential between EVs and other vehicle types, and bringing the treatment of hybrids closer to that of petrol and diesel cars.
The changes made by clauses 5 and 6 will set the company car tax appropriate percentages for the tax years 2028-29 and 2029-30. Appropriate percentages for EVs will rise by two percentage points per year, rising to 9% by 2029-30. Meanwhile, the appropriate percentages for cars with emissions of 51 grams of carbon dioxide per kilometre or over will rise by one percentage point per annum. By 2029-30, the appropriate percentages for petrol and diesel cars will rise to between 20% and 39%, depending on the car’s specific emissions. Together, the measures will gradually narrow the gap between EVs and their petrol and diesel counterparts, while maintaining a generous incentive for EVs.
On the changes to the hybrid appropriate percentages, I draw the Committee’s attention to recent research from the European Commission that has shown that the real-world emissions of hybrid vehicles are in fact three and a half times higher than previously thought. Consequently, the Government have announced that they will align the treatment of hybrids more closely with that of petrol and diesel cars.
Harriet Cross (Gordon and Buchan) (Con)
On aligning hybrid cars more closely with petrol and diesel cars, what assessment has been made of the impact on the hybrid car market and the take-up of hybrid cars, if we are ultimately looking to move away from petrol and diesel in the long term?
James Murray
Over the coming years we need to make the transition to electric vehicles. Hybrid cars obviously play an important part in the car market and car manufacturing in the UK. The clauses are about a plan over the next five years or so regarding what will happen to the appropriate percentages. This is not an overnight change. Actually, one of the important principles of our setting out the appropriate percentages now for some years in advance is to give car manufacturers and everyone interested in the car industry certainty about what will happen. That is why, as I have been setting out, the appropriate percentages for EVs will rise, thereby narrowing the gap between them and petrol and diesel vehicles, but there will still be a generous incentive to help to shift people towards purchasing EVs.
Hybrid vehicles obviously fit within the general scheme of appropriate percentages. However, as I was setting out, European Commission research shows that emissions from hybrid vehicles are in fact three and a half times higher than previously thought, so in setting the rates for 2028-29 and 2029-30, we have decided to reflect that fact in the appropriate percentages that we are legislating for. That means all cars with emissions between 1 gram and 50 grams of carbon dioxide per kilometre—those that largely fall in the hybrid category—will see their appropriate percentages rise to 18% in 2028-29 and to 19% in 2029-30. As I outlined to the hon. Member for Gordon and Buchan, by setting out the rates until 2029-30 we will give the industry and consumers certainty about the future rates.
The company car tax system offers generous incentives to encourage EV take-up and makes an important contribution to the EV transition. The Government, however, must balance incentives against responsible management of the public finances. We are announcing the rates for 2028-29 and 2029-30 to start to narrow the differentials between EVs, hybrids, and petrol and diesel vehicles. I therefore commend clauses 5 and 6 to the Committee.
Gareth Davies
As the Minister set out, clauses 5 and 6 set the appropriate percentage used for calculating the taxable benefit for a company car for tax years 2028-29 and 2029-30. In those tax years, the appropriate percentage for EVs will increase by 2% to 7% in 2028-29 and 9% in 2029-30. For most other vehicles, the appropriate percentage will increase by a further 1% in each year, up to a maximum of 39%. Hybrid vehicles are the standout exception. The effect of these clauses for vehicles capable of operating on electric power while producing between 1 gram and 50 grams of CO2 per kilometre is to introduce a steep increase in the appropriate percentage of as much as 13% in 2028-29 to reach 18%, before rising to 19% in 2029-30.
Whereas previously the appropriate percentage for cars with emissions between 1 gram and 50 grams of CO2 per kilometre would rise as the electric range reduced, from 2028-29 that system will be replaced with a single flat rate, regardless of the electric range. That means that hybrid cars with the greatest electric range, which are presumably the least polluting, will see the steepest tax rise. Any distinction between hybrid vehicles will be eliminated for the purposes of these provisions. Indeed, as the explanatory notes make very clear, rates for hybrid vehicles will align more closely with the rates for internal combustion engine vehicles, as the Minister just pointed out.
It will not have escaped Members that these new rates take us to 2030. The Government have confirmed their intention to ban the sale of new petrol and diesel cars by that date. What has not yet been confirmed is the future of hybrid vehicles. The Department for Transport is consulting on which hybrid cars can be sold alongside zero emission models between 2030 and 2035. The Minister, naturally, will not pre-empt the outcome of that consultation, but these measures effectively do just that. While the Department for Transport parses the differences between plug-in hybrid electric vehicles and hybrid electric vehicles, the Treasury is eliminating that distinction altogether by 2028, let alone by 2030.
Not only that, but the Treasury is effectively lumping all hybrid vehicles in with those powered by internal combustion engines. Treasury Ministers will be aware that the manufacturing of hybrid vehicles and engines supports thousands of British jobs, as my hon. Friend the Member for Gordon and Buchan alluded to, and car manufacturing firms operate on a multi-year investment cycle. The contradictions between the Bill and the Department for Transport’s consultation send a less than clear signal, which puts those jobs at risk. I would therefore be grateful if the Minister clarified the Government’s intention in making these changes, especially when the House of Lords Environment and Climate Change Committee has heard that these rates have been the single most effective intervention to date in changing consumer behaviour around different types of vehicles.
I would also be grateful if the Minister outlined what steps the Treasury and HMRC are taking to make the general public aware of these changes. I grant they are quite technical, but they could impose a significant additional tax bill on certain taxpayers with plug-in hybrid vehicles. The Chartered Institute of Taxation raised that as a key area of concern, which could confront unsuspecting taxpayers—those seeking to do the right thing by purchasing a less-emitting vehicle— with a massive and steep tax rise. A higher rate taxpayer on £51,000 whose company car is a plug-in hybrid VW Golf could face an additional tax bill of as much as £1,600 in 2027-28. That strikes me as neither fair nor proportionate.
It has been reported that this Labour Government ordered no fewer than 10 petrol hybrid Jaguars upon assuming office to supplement the existing departmental, chauffeur-driven pool cars. If the Minister is confident that the consequences of the changes have been communicated and fully understood, I am sure he will be able to inform the Committee of the extra tax liability in 2028-29 of someone on a salary similar to that of a Treasury Minister—£110,000—whose full-time work car is a plug-in hybrid Jaguar F-Pace valued at roughly £60,000 with an electric range of just under 40 miles.
As the Committee can tell, we have serious reservations about the communication of the changes, the unfair overnight tax hikes they impose on taxpayers just trying to do the right thing, and the mixed messages they send to vehicle manufacturers by contradicting other areas of Government policy and consultation. The measures concern the ’28-29 and ’29-30 tax years, so the Government have time to think again and to bring back a better calibrated policy in a future Finance Bill. For the reasons that I have set out, we will vote against the clauses.
James Murray
I listened to the shadow Minister’s comments, and he must have a different definition of “overnight” from me. Legislating now for changes that will come in in 2028 does not feel like overnight. Some Budget changes come in on the day of the Budget—had he called one of those overnight, I might have had some sympathy with the description, but not for legislating now for changes that will come in in 2028, toward the end of this decade. Part of the point of legislating now for changes that will happen some years down the line is precisely to give that signal to consumers and manufacturers, to ensure that the consumers are aware of what is to happen and manufacturers know what is planned.
Harriet Cross
People might be buying cars now—that is, overnight—that they still have in ’28-29, when the changes come in. They will be making decisions now that will be caught up in future changes.
James Murray
The hon. Lady makes a similar point to that made by the hon. Member for Grantham and Bourne, which is that the changes will come in further down the line, but they are critical of the fact that we are pre-announcing the changes now so that we give greater certainty and stability. I cannot understand that criticism, because I thought that giving as much forecasting, certainty and stability as possible would be welcomed by the industry and consumers. People expect taxes to change over time, and the greater the forecasting and advance notice they have, the better for consumers and for manufacturers. Without making this too political, I know that the Opposition were not a great fan of certainty and stability when they were in office, but we are rather different. That is why we are setting out the changes now.
The shadow Minister referred to the DFT consultation, and of course, he is right that I would not pre-empt its outcome. In combination, our giving information about what the appropriate percentages will be towards the end of the decade, thereby providing certainty and stability, will help us to work closely with other Departments to ensure that consumers are well informed about what is likely to happen towards the end of the decade and manufacturers have the certainty and stability that were so desperately lacking under the previous Administration.
Question put, That the clause stand part of the Bill.
James Murray
Clause 13 sets the charge for corporation tax for the financial year beginning April 2026, setting the main rate at 25%; and clause 14 sets the small profit rate at 19% for the same period. As Members know, the charge for corporation tax must be set every year, so it is important to legislate on the rate for 2026 now to provide certainty to large and very large companies, which will pay tax in advance on the basis of their estimated tax liabilities. That is also why we have committed to cap corporation tax at 25% for the duration of the Parliament, as set out in the corporate tax road map published at the autumn Budget. The changes made by clause 13 will establish the right of the Government to charge corporation tax from April 2026. The clauses maintain the current rates of 25% and the small profits rate of 19%. Tax certainty is of great importance to businesses, and clauses 13 and 14 ensure that they continue to benefit from stable and predictable tax rules. I commend both clauses to the Committee.
Gareth Davies
As the Minister set out, clauses 13 and 14 set the charge and rates of corporation tax for financial year 2026. The main rate remains unchanged at 25%, with the standard small profits rate at 19%, and the standard marginal relief fraction remains three 200ths.
In Committee on the last Finance Bill, the Exchequer Secretary to the Treasury, who was then the shadow Financial Secretary to the Treasury—a great Opposition role—told the House that if Labour won the election, they would bring certainty back for businesses by capping the rate of corporation tax at 25% for the whole of the next Parliament. At that point, he spoke of capping corporation tax and publishing a business taxation road map as though they were two separate things.
This year’s Budget makes clear that there is no cap outside the road map, and once again, as with income tax, we must take Labour at their word that they will stick to a non-binding commitment, which is not legislated for in this Finance Bill. It is unclear how much certainty or stability such a loose commitment will bring, especially when the Budget blindsided businesses with a £25 billion tax hike. Not only that, but the corporate tax road map itself says that, while the Government are committed to providing stability and predictability in the business tax system, they cannot rule out changes to the corporate tax regime over the course of this Parliament.
Given the Government’s ongoing worries about headroom and the uncertainty and instability that has created, will the Minister reconfirm for the parliamentary record the Government’s commitment, first, not to raise the headline rate of corporation tax for the duration of this Parliament; secondly, not to raise the small profits rate or reduce the marginal relief currently available; and thirdly, to maintain full expensing and the annual investment allowance, as well as writing down allowances and the structures and buildings allowance without meaningfully altering their eligibility?
James Murray
I was expecting a series of amendments from the Opposition; I was not expecting the shadow Minister to quote back at me an amendment I tabled several years ago. It is a new, although interesting, approach to opposition to rely on what I tabled in opposition and quote that back at me. I am sure it was an excellent amendment, although I cannot remember its exact detail.
On the hon. Gentleman’s questions about corporation tax rates, I am sure he will remember from his time in the Treasury that it is standard practice to legislate the charge to corporation tax on an annual basis, even when the rates remain unchanged. That is a long-standing convention that applies to income tax as well. However, because we were so determined to give businesses stability and certainty, we published the corporate tax road map alongside the Budget. In that road map, we made clear our commitment to maintaining the main rate—or, indeed, to capping it—at 25% for the duration of the Parliament.
The small profits rate and marginal relief will also be maintained at their current rates and thresholds. Full expensing and the annual investment allowance are also guaranteed for this Parliament. When it comes to corporation tax, full expensing and the annual investment allowance, the various Finance Bills in this Parliament will be quite a different experience compared with those in the previous Parliament.
Harriet Cross
Although we of course welcome a road map as a way to give businesses confidence on corporation tax, we should not get mixed up in the smoke and mirrors of what business taxes are. Because of the Budget, businesses now face many taxes and the uncertainty that they bring. Will we also see road maps for things such as the national insurance rises, the increase in business rates, minimum wage increases and measures in the Employment Rights Bill, all of which have an impact on business?
James Murray
The hon. Lady mentions business rates. I do not know whether she has read the discussion paper “Transforming Business Rates”.
James Murray
I am glad the hon. Lady has read it, because it sets out our approach to business rates in the coming year, from April 2026, and what we want to do over this Parliament. Businesses want stability and certainty from Government; they recognise that, over a five-year period, things will happen that cannot be predicted on day one, but they want that certainty and predictability. That is why, in the corporate tax road map, we give certainty on capping the main rate and on the small profits rate, marginal relief, full expensing and the annual investment allowance—everything on which we can give full certainty. However, where there are areas that we seek to explore or consult on, we are also clear about that. We developed that approach in partnership with business to make sure that we give as much certainty up front as we can, while also signposting those areas that we want to discuss.
Gareth Davies
Let us be clear: it is good when a Government set out a tax rate over a multi-year period; we accept that that is a good thing. However, does the Minister accept—to the point raised by my hon. Friend the Member for Gordon and Buchan—that although a road map has been set out on corporation tax, the Labour party has created uncertainty by saying, before the election, that it would not increase national insurance contributions and then, immediately after the election, hitting businesses with a £25 billion tax rise, including not only a rate change but a threshold change that brings many new businesses into the tax regime? Does the Minister accept that the problem is about more than corporation tax? It is about the entire business tax ecosystem. On that basis, the charge is very clear: his Government have caused great uncertainty and great damage to British businesses.
James Murray
Although I am mindful that the clauses are on corporation tax, Mr Mundell, let me briefly respond to the shadow Minister’s comments. This Government were elected to bring an end to the instability that had become endemic under the previous Government. I like the hon. Gentleman a lot, but for him to imply that the previous Government had stability from day to day is for the birds. I was in the House of Commons Chamber so many times for debates on Finance Bills. I think we went through the entire introduction and repeal of the health and social care levy in the space of a few months. There was no stability under the previous Government, and that was a large part of what led people to vote for change at the last general election. They wanted us to sort out the public finances, get public services back on their feet and restore the economic stability that is the bedrock on which investment can rise and on which we can get the economy growing as we know it can, supporting British businesses, entrepreneurs and wealth creators to do what they do best.
To bring us back to the clauses, publishing the corporate tax road map shows our commitment to not just campaigning on the prospect of bringing stability but delivering it in our very first Budget. The corporate tax road map clearly sets out our approach to corporation tax, related allowances and other areas we will look at. I may have discerned support for it in the shadow Minister’s comments; it was bound up in other comments but, reading between the lines, I think he supports the publication of the corporate tax road map. He is welcome to intervene if he disagrees.
Gareth Davies
I will intervene anyway. As I said, any certainty that can be provided to businesses regarding the tax system is a good thing. The point I am trying to make—I will try again—is that corporation tax is just one tax paid by businesses. They also pay national insurance contributions. They also use reliefs such as the business rates relief the Minister talked about—by the way, the Government have cut that from 70% to 40%, although I am not sure that it was clear before the election that they would do that. The uncertainty has been caused by all the things that the British public were told would not happen, but that then did happen.
We are talking about corporation tax today, and I can see that you are, quite rightly, about to bring us back in scope, Mr Mundell. I will leave it here by saying that British businesses pay more than just corporation tax, and what they need is certainty across the board. We have a corporation tax road map, but why do we not have a holistic, comprehensive business tax road map that includes national insurance, business rates and other taxes borne by businesses? That is my point.
James Murray
With your indulgence, Mr Mundell, I would like to briefly address—
James Murray
Yes. In the context of this discussion on corporation tax, I will address the comments about other taxes. The shadow Minister again mentioned business rates and business rates relief, but he might want to recall the situation we inherited on business rates relief. This year it is operating at a 75% discount for retail, hospitality and leisure properties, up to a cap of £110,000, and it was due to expire entirely in April 2025. What we inherited was not just instability, but a cliff edge—it was going to go entirely in April this year. I notice that that part of the story is conveniently erased from the shadow Minister’s account of history.
Business rates relief was going to expire entirely in April 2025, so we were keen to ensure that we continued it, while being mindful of the public finances. Our decision to continue it for a further year at 40% was the right thing to do while we ensure that we are ready from April 2026 to have permanently lower tax rates for retail, hospitality and leisure businesses with a rateable value of below £500,000. That is the stability that businesses so badly need. Frankly, the shadow Minister, who is talking about business rates in the context of corporation tax, overlooked that fact entirely. Under the previous Government, the reliefs were extended one year at a time, with the rates going up and down, which provided no stability for businesses trying to make investment decisions. From April 2026, with our permanently lower rates, we want to provide exactly that stability.
To return to corporation tax, which is the subject of these two clauses, one of the conversations that I had many a time with businesses while in opposition was about their desire for certainty on corporation tax and the system of allowances. I recall challenging the shadow Minister, when he was a Treasury Minister himself, about the number of changes there had been to full expensing, the annual investment allowance and indeed to the super-deduction, which came and went entirely within one Parliament. That instability is what prompted our desire to provide stability for businesses, and publishing the corporation tax road map and these clauses begins to implement the commitments we made.
Question put and agreed to.
Clause 13 accordingly ordered to stand part of the Bill.
Clause 14 ordered to stand part of the Bill.
Clause 19
Pillar Two
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Government amendments 1 to 3, 21 to 23, 4 to 11, 24 to 29, 12 and 13, 30, 14, and 31 to 37.
Schedule 4.
James Murray
Clause 19 and schedule 4 introduce the undertaxed profits rule—the third and final part of the internationally agreed global minimum tax known as pillar two. They also amend the existing legislation on multinational top-up tax and domestic top-up tax to incorporate the latest international agreements and stakeholder feedback.
It is essential that multinationals pay their fair share of tax in the UK. Pillar two protects the UK tax base from large multinationals shifting their profits overseas to low-tax jurisdictions, by requiring multinationals that generate annual revenues of more than €750 million to pay an effective tax rate of 15% on their profits in every jurisdiction in which they operate. Where their effective tax rate falls below that, they will pay a top-up tax.
James Wild (North West Norfolk) (Con)
It is a great pleasure to serve on the Committee under your chairmanship, Mr Mundell. As we heard from the Minister, clause 19 and schedule 4 amend the parts and schedules of the Finance (No. 2) Act 2023 that implement the multinational top-up tax and domestic top-up tax. Part 2 of schedule 4 introduces the undertaxed profits rule into UK legislation, and part 3 makes amendments to the multinational top-up tax and domestic top-up tax. These taxes represent the UK’s adoption of the OECD pillar two global minimum tax rules, and we are supportive of the measures before us.
In October 2021, under an OECD inclusive framework, more than 130 countries agreed to enact a two-pillar solution to address the challenges arising from the digitalisation of the economy. Pillar one involves a partial reallocation of taxing rights over the profits of multinationals to the jurisdictions where consumers are located. The detailed rules that will deliver pillar one are still under development by the inclusive framework. As the Minister said, pillar two introduces a global effective tax rate, whereby multinational groups with revenue of more than €750 million are subject to a minimum effective rate of 15% on income arising in low-tax jurisdictions.
The multinational and domestic tax top-ups were introduced in the Finance Act 2023, as the first tranche of the UK’s implementation of the agreed pillar two framework. Measures in the Bill extend the top-up taxes to give effect to the undertaxed profits rule. That brings a share of top-up taxes that are not paid under another jurisdiction’s income inclusion rule or domestic top-up tax rule into charge in the UK. The undertaxed profits rule will be effective for accounting periods beginning on or after 31 December 2024.
Following discussions with the Chartered Institute of Taxation, I have a number of points to raise with the Minister. First, as the institute points out, there is an open point around the application of the transitional safe-harbour anti-arbitrage rules. The OECD’s anti-arbitrage rules for the transitional safe harbours are drafted very broadly, and may therefore go further than originally anticipated. Will the Minister clarify HMRC’s view of the scope of those rules?
There are also questions about taxpayers’ ability to qualify for the transitional safe harbours. A transitional safe harbour is a temporary measure that reduces the compliance burden for multinationals and tax authorities. There has been some uncertainty as to whether a single error in a country-by-country report could disqualify all jurisdictions from applying the transitional safe harbours. HMRC has recently indicated that it would be open to permitting re-filings of country-by-country reports where errors are spotted. Can the Minister provide further clarity on HMRC’s proposed approach?
The UK’s legislation will need to be updated regularly to stay in line with the OECD’s evolving guidance. What steps is the Minister taking to ensure that clear guidance is provided in a timely manner? The new top-up taxes and undertaxed profits rule are complicated. Schedule 4 runs to over 40 pages and includes an eight-step method to determine the proportion of an untaxed amount to be allocated to the UK. It is important that the Government minimise the cost of implementation and compliance. How will the Minister ensure that it is kept to a minimum?
While I welcome the work the UK is doing at a global level, there are still significant issues. I was interested, as I am sure the Minister was, to see that one of the first actions of President Trump, just hours after he took office, was to issue a presidential memorandum stating:
“This memorandum recaptures our nation’s sovereignty and economic competitiveness by clarifying that the global tax deal has no force or effect in the United States.”
It states in clear and unambiguous terms:
“The Secretary of the Treasury and the Permanent Representative of the United States to the OECD shall notify the OECD that any commitments made by the prior administration on behalf of the United States with respect to the global tax deal have no force or effect within the United States absent an act by the Congress adopting the relevant provisions of the global tax deal.”
The OBR estimates that pillar two is expected to generate £2.8 billion by the end of this Parliament. What impact could the US position have on the future operation of pillar two and the UK’s ability to levy top-up taxes on multinationals as planned? The same memorandum issued by President Trump notes that
“a list of options for protective measures”
will be drawn up within 60 days. What action are the Government taking to engage with the US Treasury and to prepare for such actions? Has the Chancellor raised this with her opposite number?
The Minister referred to the more than 30 Government amendments that have been tabled to schedule 4, which correct errors in the calculation of the multinational top-up tax payable under the UTPR provisions that would have resulted in an excessive liability; secure that eligible payroll costs and eligible asset amounts are allocated from flow-through entities in a manner that is consistent with pillar two model rules; and ensure that multinational top-up tax and domestic top-up tax apply properly in cases involving joint ventures. They are all perfectly sensible, but the number of amendments tabled underlines the complexity of the issue.
As I mentioned, this is a two-pillar system. The corporate tax road map confirmed the Government’s support for the international agreement on a multilateral solution under pillar one and the intention to repeal the UK’s digital sales tax when that solution is in place. The digital sales tax raised £380 million in 2021-22, £567 million in 2022-23 and £678 million in 2023-24. I would welcome an update from the Minister on pillar one and the future of the digital sales tax.
The Opposition will not be opposing the clause, but I look forward to the Minister’s response to the specific points I have raised, including those on developments under the new Trump Administration and on implementation.
James Murray
I thank the shadow Minister for his support for the provisions before us and our general approach.
First, it is the case that we are amending the Bill in Committee, but that is because, as his colleagues may remember from their time in government, these are complex rules and it is important that pillar two rules work as intended. This is a complex international agreement and it represents one of the most significant reforms of international taxation for a century. It is to a degree inevitable that revisions would be needed as countries and businesses introduce pillar two and set it in progress. It is complex, but we should not forget that pillar two applies only to large multinational businesses, and the reason it is being introduced is to stop those businesses shifting their profits to low-tax jurisdictions and not paying their fair share here in the UK. The rules need to respond to that, and we need to make sure that they work for all sectors and all types of businesses.
James Murray
The clause repeals the offshore receipts in respect of intangible property legislation, known as ORIP, which was aimed at disincentivising large multinational enterprises from holding intangible property in a low-tax jurisdiction if the intangible property was used to generate income in the UK. Such enterprises could thereby gain an unfair competitive advantage over those that held intangible property in the UK. The policy is no longer required, because pillar two—the global minimum tax—will more comprehensively discourage the multinational tax planning arrangements that ORIP sought to counter.
As set out in the corporate tax road map, which we debated earlier, the Government are committed to simplification of the UK’s rules for taxing cross-border activities in the light of pillar two. Repeal will take place alongside the introduction of pillar two’s undertaxed profit rules in the UK from 31 December 2024, which we debated with clause 19. Clause 20 simply repeals chapter 2A of part 5 of the Income Tax (Trading and Other Income) Act 2005, and I commend it to the Committee.
James Wild
As we heard from the Minister, clause 20 repeals the ORIP rules, which are about ensuring that profits derived from UK consumers are taxed fairly and consistently, regardless of where the underlying intangible property is held. The previous Government announced in the 2023 autumn statement that they would abolish ORIP, so we support the clause.
The ORIP rules were a short-term, unilateral measure introduced in the Finance Act 2019 to disincentivise large multinational enterprises from holding intangible property—assets such as patents, trademarks and copyrights—in low-tax jurisdictions if it was used to generate income in the UK. Such multinationals could thereby gain an unfair competitive advantage over others that hold intangible property in the UK, as well as eroding the UK tax base. However, the legislation is no longer required, because the OECD/G20 inclusive framework pillar two global minimum tax rules will comprehensively discourage the multinational tax planning arrangements that ORIP sought to counter.
As the Minister said, the repeal will happen alongside the introduction of the pillar two undertaxed profits rule from 31 December 2024. Has he assessed how successful the ORIP rules have been since their introduction? HMRC’s tax information and impact notes state that this measure will have a negligible impact on around 30 large multinational groups and a negative impact on the Exchequer, peaking at £40 million in 2026-27. Can the Minister clarify why the repeal of the ORIP rules is having a negative impact on revenues to the Exchequer? I note that the Chartered Institute of Taxation has welcomed the measure and specifically said that
“any reduction in the legislative code to minimise overlap and unnecessary measures is welcome.”
We say amen to that.
As I have set out, we will not oppose the clause, but I look forward to the Minister’s response to my specific points about ORIP.
James Murray
I thank the shadow Minister for his support for the clause. I think his question was about the impact of repealing ORIP. A fundamental point here is that pillar two, which we debated previously, will now tax the profits that were the target of ORIP. Pillar two is expected to raise more than £15 billion over the next six years, so ORIP is simply no longer needed. The Government believe that simplifying and rationalising the UK’s rules for taxing cross-border activities is important, and as such it is right that we use this opportunity to repeal ORIP.
Question put and agreed to.
Clause 20 accordingly ordered to stand part of the Bill.
Clause 21
Application of PAYE in relation to internationally mobile employees etc.
James Murray
I beg to move amendment 15, in clause 21, page 11, line 21, after “is” insert “or has been”.
This amendment makes it clear that new section 690 applies if an employee has been internationally mobile in a tax year, even if the employee is no longer internationally mobile.
The Chair
With this it will be convenient to discuss the following:
Government amendments 16 to 19.
Clause stand part.
James Murray
I will briefly address clause 21 before explaining what the amendment seeks to achieve.
The clause makes changes to simplify the process for operating pay-as-you-earn where an employee is eligible for overseas workday relief. It relates to some of the reforms we are making around non-UK domiciled individuals, which we will return to later in Committee, because those clauses are in a different part of the Bill. More broadly, the context of this measure is that the Government are removing the outdated concept of domicile status from the tax system, and replacing it with a new, internationally competitive, residence-based regime from 6 April 2025.
Currently, where an employer makes an application to treat only a portion of the income that they pay to an employee as PAYE income, they are required to wait for HMRC to approve an application, which can result in delays. The changes made by clause 21 will mean that from 6 April 2025, an employer will be able to operate PAYE only on income relating to work done in the UK once they have received an acknowledgment from HMRC of their completed application, rather than having to wait for HMRC to approve it. That approach will simplify the operation of overseas workday relief for employers, while still allowing HMRC to direct employers to amend the proportion of income on which PAYE is operated, should it be necessary to do so.
Amendments 15 to 19 are needed in order to ensure that the legislation regarding the correct operation of PAYE works as intended. The Government are committed to making the tax system fairer so that everyone who is a long-term resident in the UK pays their taxes here. The new regime ensures this, while also being more attractive than the current approach, as individuals will be able to bring income and gains into the UK without attracting an additional tax charge. That will encourage them to spend and invest those funds in the UK.
James Wild
As we have heard from the Minister, clause 21 amends the process by which employers can operate PAYE on a proportion of payments of employment income made to an employee during the tax year. It is a welcome change. We will be supporting the clause and the simplification that it introduces.
By way of background, the clause amends section 690 of the Income Tax (Earnings and Pensions) Act 2003. Section 690 provides a mechanism for an individual or employer to seek a decision from HMRC regarding the tax treatment of certain earnings. The resulting determination under section 690 is an agreement between HMRC and a UK employer on the estimated percentage of duties that an internationally mobile employee expects to carry out in a tax year. Once that determination is provided, the employer can operate PAYE on only that percentage of the employee’s salary.
Unfortunately, that is easier said than done. According to the Institute of Chartered Accountants in England and Wales, historically HMRC has missed its four-month target to agree employers’ applications, and in some cases it has taken up to a year to obtain HMRC’s approval. This is just one example of the difficulty that taxpayers have in engaging with HMRC. I welcome the comments that the Minister made at Treasury questions last week about the work that he is doing—he chairs the board of HMRC, I believe—to ensure that HMRC delivers a better service for customers. We all wish him well on that.
Perhaps this is an opportune time to remind the 3.4 million people who have to submit self-assessment tax returns to do so before the 31 January deadline. Colleagues may wish to ensure that they have submitted theirs.
In the absence of an agreement, PAYE must be operated on the whole salary, meaning that the employee would be overtaxed and must claim relief after the year end. That is not a satisfactory outcome for anyone. These changes will allow employers to immediately operate PAYE on only the proportion of earnings that they believe relates to UK duties, rather than having to wait for HMRC to approve the application. This new process is a welcome step forward in dealing with an issue that HMRC has had in meeting its legal obligations under the current tax system.
James Murray
I thank the shadow Minister for his support for the clause and the amendments. He rightly recognises that this is a simplification to make things happen quicker in the tax system, and we can all agree on that. He raised some specific points, and I will write to him on the detail of the operation of the clause so that he has a record of that. I endorse his call for anyone who has not already submitted their self-assessment tax return to be mindful of the deadline of the end of the month.
Amendment 15 agreed to.
Amendments made: 16, in clause 21, page 12, line 4, after “being” insert “or having been”.
This amendment is consequential on Amendment 15.
Amendment 17, in clause 21, page 12, line 22, after “is” insert “or has been”.
This amendment makes it clear that a notice under new section 690A can be given during the mobile tax year if the employee has been internationally mobile during that year, even if the employee is no longer internationally mobile.
Amendment 18, in clause 21, page 13, line 22, leave out “public notice given” and insert “general direction made”.
This amendment means that the requirements of notices under new section 690A will be specified in a general direction made by HMRC rather than a public notice.
Amendment 19, in clause 21, page 15, line 38, at end insert—
“(3) Any direction given by an officer of Revenue and Customs under section 690 of ITEPA 2003 (employee non-resident etc) has no effect in relation to tax year 2025-2026 or any subsequent tax year.” —(James Murray.)
This amendment means that any direction given under the old section 690 will cease to have effect in relation to future tax years.
Clause 21, as amended, agreed to.
Clause 22
Advance pricing agreements: indirect participation in financing cases
Question proposed, That the clause stand part of the Bill.
James Murray
Clause 22 introduces technical amendments to provide certainty that advance pricing agreements are available for all financing arrangements covered by the transfer pricing rules, in line with the existing HMRC guidance.
The transfer pricing rules ensure that transactions between related parties, such as companies in the same multinational group, are priced as though they were between independent entities, in line with the arm’s length principle. This makes sure that each related party pays the appropriate amount of tax in the country in which it operates. That ensures a fair distribution of tax revenues across different jurisdictions and prevents companies from manipulating intra-group prices to shift profits to lower tax jurisdictions.
The UK’s advance pricing agreement legislation provides for agreements to be entered into between HMRC and businesses in scope of the transfer pricing rules, which determine the transfer pricing method that businesses should use to determine the arm’s length price. An advance pricing agreement is not special treatment for that taxpayer; rather, it provides improved certainty to taxpayers in areas where the correct application of the transfer pricing rules may be in doubt.
HMRC has recently become aware of a technical gap in the legislation that was contrary to its long-established statement of practice. The said statement of practice allows for an advance pricing agreement to be entered into where the parties are acting together in relation to financing arrangements. The changes made by this clause fix that gap and will ensure that HMRC can provide businesses with tax certainty in relation to the application of the transfer pricing legislation to all in-scope financing arrangements, in line with HMRC’s statement of practice.
The intention of this clause is to fix a technical gap in existing legislation and to ensure that HMRC can provide certainty in line with its existing published guidance.
James Wild
As we heard from the Minister, clause 22 makes amendments to parts 4 and 5 of the Taxation (International and Other Provisions) Act 2010 concerning the meaning of indirect participation in relation to advance pricing agreements. Once again, we welcome these changes. An APA is a procedural agreement between one or more taxpayers or one or more tax authorities on the future application of transfer pricing policies. Advance pricing agreements can help to provide certainty and avoid transfer pricing disputes.
HMRC recently became aware that there is a technical gap in the circumstances in which an advance pricing agreement may be entered into. Clause 22 aims to rectify that gap and provide clarity on what constitutes indirect participation in the context of APAs. The clause amends both the transfer pricing and APA legislation to ensure the validity of advance pricing agreements in cases where the parties to the provision are connected only by virtue of acting together in relation to the financing arrangements.
The clause will ensure the validity of advance pricing agreements with businesses in such circumstances and is intended to ensure that HMRC can provide businesses with tax certainty in relation to the application of transfer pricing legislation. We have spoken a lot during this Committee about the importance of certainty for business, so that is a welcome step.
By providing clarification on what indirect participation means, the Government are confirming the scope of advance pricing agreements, which should improve certainty and dispute resolution. The Chartered Institute of Taxation notes that
“this measure will be helpful for taxpayers that have applied to or want to apply to HMRC for APAs in relation to financing arrangements (such as Advance Thin Capitalisation Agreements) in circumstances where the UK’s transfer pricing rules are only in scope due to persons acting together in relation to those financing arrangements.”
The clause will likely improve the process both for businesses and HMRC. It is, however, a little hard to understand the real-world impact from the tax information and impact notes. Now that indirect participation has been defined and the scope of advance pricing agreements effectively broadened, will there be any extra enforcement cost? I would be grateful if the Minister could confirm how many businesses the change is likely to impact. It would also be useful to know whether the Government have calculated the economic benefits of advance pricing agreements and, subsequently, how the change will impact the Exchequer. As I have set out, we welcome this technical change, but I would welcome the Minister’s comments on the issues I have raised.
James Murray
I thank the hon. Gentleman for his support for the clause. We are on a roll of him supporting clause after clause—may this continue throughout the rest of the Bill.
The hon. Gentleman rightly recognises that this is a simplification measure on which all Members can agree. As it is a simplification measure, it is non-scoring, so it does not have an Exchequer impact—it simply provides certainty on how the rules as intended will apply. It does not change how the rules apply or make a policy change to the Government’s approach; it makes sure that there is total certainty and clarity about how they will apply. Only a limited number of taxpayers will be affected, and we expect them to welcome the change because of this certainty.
I welcome the Opposition’s support for this clause, because I think we can all agree on giving as much certainty to taxpayers and businesses as possible.
Question put and agreed to.
Clause 22 accordingly ordered to stand part of the Bill.
Clause 23
Expenditure on zero-emission cars
Question proposed, That the clause stand part of the Bill.
James Murray
Clauses 23 and 24 make changes to extend the 100% first-year allowances for qualifying expenditure on zero emission cars and plant or machinery for electric vehicle charge points by a further year to April 2026. The first-year allowance for cars was originally introduced for expenditure incurred from 17 April 2002 for low CO2-emission cars, including electric vehicles, and eligibility was later restricted to cars with zero CO2 emissions from April 2021. The first-year allowance for electric vehicle charge points was originally introduced for expenditure incurred from 23 November 2016. These first-year allowances were introduced to support the UK’s transition to cleaner vehicles and were due to expire in April 2025.
The changes made by clauses 23 and 24 will extend the availability of the capital allowances for a further year to 31 March 2026 for corporation tax purposes and 5 April 2026 for income tax purposes. This ensures that investments in zero emission cars and charge point infrastructure continue to receive the most generous capital allowance treatment. By extending the first-year allowances for zero emission cars and charge point infrastructure, the measure will provide continued support for the transition to electric vehicles.
Gareth Davies
As the Minister set out, clauses 23 and 24 extend the availability of the 100% first-year allowance for business expenditure on zero emission cars and for expenditure on plant or machinery for an electric vehicle charging point. Both allowances are extended for a single year from April 2025. In their current forms, both allowances were introduced by Conservative Governments. Although we will not oppose the clauses, there are a few questions that I would like the Minister to address.
The first relates to a point that has been highlighted by the Association of Taxation Technicians concerning clause 24. The ATT has queried why the specific allowance for charging points is being extended when this expenditure has been covered by both the annual investment allowance and full expensing since the Conservative Government made those reliefs permanent in 2023. That means that the allowance is really relevant only to unincorporated business—for example, a partnership or sole trader— that has already used its annual investment allowance in full, which is a scenario that the ATT considers to be quite rare.
According to the ATT, we should be able to tell how rare this is from the number of claims made for this specific allowance on tax returns. Will the Minister provide any information that he has to hand on that? HMRC has said it expects 6,000 unincorporated businesses to be impacted by clauses 23 and 24. Does the Minister have a figure for clause 24 alone and for specific unincorporated businesses that have exhausted their annual investment allowance? At the very least, I would be grateful if the Minister explained to the Committee the rationale behind that specific extension, given the context that the ATT has so clearly set out.
The cost to HMRC of implementing the clauses is a cool £1.2 million—a relatively high figure for the extension of a pre-existing allowance for a single year. If clause 24 is largely redundant, this hardly seems good value for money on HMRC’s part. I therefore ask the Minister to provide a clause-by-clause breakdown of the £1.2 million of taxpayers’ money that HMRC will spend to be able to execute the relief.
Turning back to clause 23, electric vehicles, unlike charging points, are not in scope of the annual investment allowance or full expensing, so I will not question the extension of that specific allowance, which we welcome. However, given the Government’s ambition to accelerate our transition to electric vehicles, I cannot help but wonder why they are putting a brake on the allowance after just a single year.
The Red Book states that the allowance will
“help drive the transition to electric vehicles”,
yet from April 2026, a business investing in these cars will receive relief only through annual writing-down allowances of either 18% or 6%, depending on the car’s emissions—those incentives are less generous and less immediate. At Budget 2020, we extended the EV allowance by four years to provide the support and certainty to businesses that the Minister says he so desperately wants. This Labour Government have declined to do the same, creating what some—not me—may call a cliff edge. As Labour increases the pace and the burden of the transition to net zero, they are also shifting the burden away from His Majesty’s Government and on to British businesses and British consumers. Once again, it is they who will pay the price for the Government’s obsession with decarbonising our grid and imposing net zero policies on the British public.
James Murray
I thank the shadow Minister for his questions and his support for the clause. He mentioned a question that the ATT raised about the interaction between the extension of the 100% first-year allowance we are proposing, particularly for charge points, and the context of full expensing in the annual investment allowance. For businesses that are investing over the annual investment allowance limit, there may be circumstances where, if the first year allowance were not extended as it is by these clauses, some investment in EV charge point equipment would qualify for only a 50% first-year allowance rather than 100% full expensing. The Government want to support investment in EV charge point infrastructure by providing full relief for investment in equipment for EV charge points. That is why we have introduced this measure.
The shadow Minister asked for a specific figure. I do not have that to hand, but I am happy to look into what information is available and get back to him. More broadly, the 100% first-year allowance was due to expire in April 2025. This conversation has echoes of an earlier discussion we had around retail, hospitality and leisure business rates relief, and reliefs or allowances that we inherited and which are due to expire in April 2025. We have decided to extend this, and the reason why is to help support businesses and individuals who are buying or making electric vehicles and associated infrastructure. We see this as one of a series of measures to support the EV transition. It has come up in relation to a number of clauses, so I think it is clear to the Committee that the Government are pursuing a range of different interventions and policies to carefully calibrate the right level of Government support.
Blake Stephenson (Mid Bedfordshire) (Con)
In the interest of providing certainty, would the Minister explain why the Government did not choose a multi-year allowance on this, rather than going for an extension of only one year?
James Murray
As I was saying, we are seeking to calibrate the incentives carefully for the transition to EVs to support manufacturers and consumers and to give as much certainty as possible, while making sure that we have the right support in different parts of the tax system to provide value for money and support the transition in the right way. It is not a question of a single measure being responsible for supporting the transition. This relies on manufacturers and consumers playing their part, but the Government need to play their role, too, which is why this measure sits alongside others we have debated, including those that are not part of the Finance Bill but are part of the Government’s broader agenda. Collectively, they will support this transition.
Question put and agreed to.
Clause 23 accordingly ordered to stand part of the Bill.
Clause 24 ordered to stand part of the Bill.
Clause 25
Commercial letting of furnished holiday accommodation
Question proposed, That the clause stand part of the Bill.
James Murray
The clause and the schedule abolish the furnished holiday lettings tax regime from April 2025, removing the tax advantages that landlords who offer short-term holiday lets have over those who provide standard residential properties. Furnished holiday let owners benefit from a more generous tax regime than landlords of other property types, such as standard residential properties. The advantages of that tax regime include capital gains tax reliefs: FHLs can qualify for gains to be charged at 10%, unlike buy-to-let properties and second homes. FHLs also benefit from unrestricted income tax relief on their mortgage interest, rather than the 20% restriction on relief for standard lettings, and from capital allowance on furniture and furnishings. FHL profits are also counted as earned income for pension purposes.
The previous Government announced at the spring Budget 2024 that they would abolish the FHL tax regime to level the playing field with landlords of standard residential properties. We are now legislating for that measure and abolishing the FHL tax regime from April 2025, which will raise around £190 million a year by 2029-30 and thereby support the vital public services we all rely on. The changes made by clause 25 and schedule 5 mean that FHL landlords will be treated the same as other residential landlords for the purposes of income tax, corporation tax and capital gains tax.
Harriet Cross
Does the Minister recognise the difference between properties with a use clause compelling them to be used for holiday let accommodation and houses that do not, and that can therefore be used as residential properties? Those two things do not necessarily line up in terms of what the owner can use the property for.
James Murray
If I understand the hon. Member’s question correctly, it might relate to clauses in the lease of the property, but I am not quite sure what her point was. I will come back to this if I have misunderstood her question, but clause 5 relates specifically to the tax treatment of these properties. It is about how FHLs, which can still operate in the same way as they have previously in terms of lettings, will be treated by the tax system to bring them in line with standard residential property tax treatment. This is about equalising the tax treatment of FHL landlords and standard landlords, rather than seeking broader changes, which may be what she was alluding to, but I am happy to return to it later in the debate if I have misunderstood her question.
This measure does not penalise the provision of FHLs; it simply brings their tax treatment more in line with long-term lets. It does that to remove the tax advantages that FHL landlords have received over other property businesses in four key areas. First, finance cost relief will apply in the same way as for long-term lettings, with income tax relief on their mortgage interest restricted to the basic rate. Secondly, it will remove the capital allowances rule for new expenditure and allow replacement of domestic items relief. Thirdly, it will withdraw access to reliefs from taxes on chargeable gains for trading business assets. Fourthly, FHL income will no longer count as earned income for pension purposes. After repeal, former FHL properties will form part of a person’s UK or overseas property business and be subject to the same rules as non-furnished holiday let property businesses.
However, the Bill does not equalise tax treatment entirely. Holiday lets, whether they qualify as FHLs or not, are subject to VAT, whereas longer-term, private rented sector accommodation is not. Withdrawal of finance cost relief will mainly affect higher rate and additional rate taxpayers, with basic rate payers largely unaffected. The Government have also introduced transitional arrangements. FHL properties will become part of a person’s overall property business and past FHL losses can be relieved against profits of that business in future years. Existing capital allowance claims can be continued, but new capital expenditure will be dealt with under the rules for standard residential let properties. The legislation also confirms that where a business has ceased prior to April 2025, business asset disposal relief may continue to apply to a disposal that occurs within the normal three-year period following cessation, which is in line with current rules.
Mr Angus MacDonald (Inverness, Skye and West Ross-shire) (LD)
Did the Minister consider the different legislation in Scotland, where we have short-term letting licences, visitor tax and a whole load of extra legislation coming in, which is making it difficult and reducing the amount of holiday letting available? How relevant is the proposal for Scotland?
James Murray
The hon. Gentleman’s question goes slightly beyond the ambit of the tax measures we are discussing. As I understand, he is talking about the wider regulation and the approach to lettings in Scotland. To echo my response to the hon. Member for Gordon and Buchan, the measures really relate to the tax treatment of FHLs in comparison to standard property lettings, making them more equal. It does not make them entirely equal—VAT remains a point of difference—but it is about levelling the playing field between FHL landlords and the landlords of standard lettings in the tax system.
Mr MacDonald
My point was really about the cumulative effect of many different taxes and restrictions making it more and more difficult for people in the letting business, which is crucial to the economy of tourist areas.
James Murray
We know that in any local area there needs to be a balance between visitor accommodation and long-term accommodation. I am sure that the hon. Member and others recognise the tension inherent in getting that balance right. We need to ensure not only that we are supporting our visitor economy, but that the tax system supports long-term accommodation for people who live in those areas—not least because those who work in the tourism sector need somewhere to live near their place of work. It is about the balance between supporting visitor economies and long-term residential lets. We agree with the previous Government, who introduced the reform, on this point. The tax treatment of FHL landlords is better if brought more in line with standard residential lets.
I will briefly mention the anti-forestalling rule, which is also introduced as part of the Bill. It will prevent the obtaining of a tax advantage through the use of conditional contracts to receive capital gains relief under the current FHL rules. That rule applies from 6 March 2024.
In summary, the changes made by the provisions will make the tax system fairer by eliminating tax advantages for landlords who let out their properties as short-term furnished holiday lets compared with those who let out properties for longer periods. FHL landlords will now be treated the same as other residential landlords for the purposes of income tax, corporation tax and capital gains tax. We are grateful to all the stakeholders who have already fed in following the publication of the draft legislation and supporting documents.
Gareth Davies
As the Minister set out, clause 25 and schedule 5 repeal special tax rules relating to the commercial letting of furnished holiday accommodation. The changes were first announced in our Government’s Budget in March 2024, and we will not oppose them. However, it is important to view the measures in the context of the wider changes to the circumstances of the hospitality sector as a result of Labour’s Budget—most notably the hike in national insurance contributions.
Yuan Yang (Earley and Woodley) (Lab)
Might it not be more appropriate to view the measure in the context of the housing crisis that our country is currently in, and the record proportion of under-35s living at home with their parents rather than being able to live in their own accommodation? Does the hon. Member agree that there should be no tax incentives for accommodation to be turned into short-term furnished lets as opposed to long-term living places?
The Chair
Order. Can we keep the discussion within the context of the clause and the schedule?
Gareth Davies
Thank you, Mr Mundell. I am grateful for the hon. Member’s intervention; we all want to see people able to get on the housing ladder, particularly younger people. There is much work to be done on that. However, I would say two things. First, I question how much of an impact the measures will have on that, but I am happy to see evidence and data from the Treasury to prove her point. Secondly, we cannot deny that the hospitality sector is in different circumstances to when the previous Government announced the measures in March 2024. As I will discuss, the measures will have an impact on the sector. I think the hon. Member would agree that it is important to support our hospitality sector, hear their concerns and for me, as the official Opposition spokesperson, to make remarks on their behalf.
As I was saying, this is not just about national insurance contributions, but the reduction in the secondary threshold for that tax, as well as the reduction in business rates relief, which has gone down from 70% to 40%. Each of those measures creates significant new costs for the hospitality sector, which is crucial to rural and coastal economies across the country. It is those same rural and coastal economies that will be disproportionately affected by the provisions of clause 25 and schedule 5.
Blake Stephenson
Does my hon. Friend think that, by suggesting that farmers should diversify into holiday lets, the Environment Secretary intends that farmers should pay even more tax to the Treasury?
Gareth Davies
It is clear that the Government have launched an attack on farmers across rural communities in our country. The family farm tax is a disgrace. Farmers have protested and tried to make their voices heard, but still cannot get a meeting with the Chancellor of the Exchequer. I urge the Minister, who is very open to meetings, to have a word with his Chancellor, who is consistently in hiding and running out of the country when things get difficult as a result of her decisions.
Perhaps it is true that the Environment Secretary wants farmers to pay even more tax. Why else would he say to farmers in Oxford, “Convert your barns into holiday lets,” while over the road the Treasury is taking away these reliefs and making it more tax inefficient for them to do so? This is yet another area where the Labour Government seem intent on cancelling out genuinely pro-growth deregulation, which we welcome, with anti-growth taxation.
Gareth Davies
Does the Labour Member who is about to intervene on me support holiday lets?
Yuan Yang
I am glad that we have returned to this topic, because I was about to ask the hon. Gentleman whether he might clarify the relationship between his remarks and the commercial letting of furnished holiday accommodation—[Interruption.] But of course I support the equalisation of tax measures provided for by the clause.
Gareth Davies
I am sorry, but there was a very loud cough when the hon. Lady intervened. Would she repeat her intervention?
Gareth Davies
Oh, so it was more of a heckle than an intervention, but that is very welcome too; it makes it a bit more lively for the very large audience we have today.
I would be grateful if the Minister could set out the policy of this Labour Government. Do they support holiday lets? The Environment Secretary clearly supports them and wants farmers to diversify into them, while at the same time the Treasury—yes, we announced the policy in March—clearly wants to tighten up the rules on taxation. It would be great to hear the Minister clarify that, but it seems that the answer depends on which Minister one talks to on any given day. Let us see what the answer is in this Committee, from this Minister, today.
Clause 25 also touches on a long-standing issue of whether letting constitutes a trading activity or a property business. The FHL regime created a clear distinction by deeming a letting business to be considered a trade for certain purposes. Some organisations, such as the excellent Chartered Institute of Taxation, are concerned that removing the regime removes this distinction and could open up a whole can of worms, leading to costly disputes for both the taxpayer and HMRC. Can the Minister clarify what defines a letting as a trading activity in the absence of the FHL regime, or at least commit to the publication of updated, clearer guidance for the industry on that subject? The Chartered Institute of Taxation is also seeking confirmation on the following points—
Rachel Blake (Cities of London and Westminster) (Lab/Co-op)
I am confused as to why a party that brought in the proposals is now arguing so vehemently against them—perhaps it is still attached to its chaotic approach to government. What I am not following in the hon. Gentleman’s remarks is the argument that the equalisation of the taxation could have negative consequences. Has the hon. Gentleman interrogated the evidence that has been brought forward by those people who are letting out their holiday lets, and does he really think that there would not be an economic benefit to supporting a change in use of those homes?
Gareth Davies
These sittings are long, but I did say at the beginning of my speech that we announced in March 2024 that we would bring in this same measure and that we will support it today.
I am not saying that we are against it, but I am saying two things. First, as I was saying at the beginning of my speech, the context in which the measure is being introduced is very different from the context in March 2024. The context today is that hospitality businesses across the country, but particularly in rural communities, are being hit by a series of taxes that they did not ask for, did not vote for and were told would not happen. That is the context in which we find ourselves.
Secondly, His Majesty’s official Opposition have a duty to communicate the concerns of the British public and the sectors that will be directly impacted by this measure. It is vital that His Majesty’s Opposition scrutinise whatever policies are put in front of us, with a forward look at how that will economically damage or benefit communities. As you can tell, Mr Mundell, and as the hon. Member for Cities of London and Westminster can tell, I take a constructive tone. When we do support measures, we will say so, and when we do not, or we feel that additional scrutiny is needed, Members better believe that I will be there. That is what I am doing today. I hope that addresses the intervention from the hon. Member for Cities of London and Westminster.
In the interests of scrutiny on behalf of the many thousands of people that will be impacted by the measure and in a context of a wider hammering through the tax system by this Labour Government, let me continue my questions on behalf of the Chartered Institute of Taxation.
First of all, I seek confirmation from the Minister that an FHL disposal must be made before 6 April 2025 in order for a qualifying replacement asset to be eligible for roll-over relief, even though the replacement asset itself can be purchased up to three years after FHL disposal. Secondly, I seek confirmation that lettings must cease altogether before 6 April 2025—not just furnished holiday lettings, but even unfurnished long-term rentals—for an FHL disposal to qualify for business asset disposal relief. Thirdly, I seek confirmation that married couples or civil partners who jointly own an FHL must make an election if they are to continue to split the income unequally, rather than reverting to the normal 50:50 rule, and make a declaration to HMRC before 6 April 2025 if this is to have effect in the 2025-26 tax year. I ask those questions constructively, on behalf of the Chartered Institute of Taxation, and if the Exchequer Secretary is not able to answer them, of course I will take a written answer by way of letter following this sitting.
In addition to the confirmation on those three points, I would be grateful if the Minister could provide reassurance that HMRC guidance has been specifically and sufficiently clear on these points, so that those affected are aware of the implications of the changes. It is important to remember that when the Government make changes and when we made changes, we were very conscious—I am sure he is too—that the public are aware. He should take all measures possible to ensure that people are aware of these changes, but I appreciate his guidance on what measures are being taken.
Finally, on the case of joint ownership—
The Chair
It is finally, because we are at 25 minutes past 11, and the Committee will now adjourn.
Tobacco and Vapes Bill (Thirteenth sitting)
Tuesday 28th January 2025
(2 days, 18 hours ago)
Public Bill CommitteesRead Full debate Tobacco and Vapes Bill 2024-26 View all Tobacco and Vapes Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 January 2025 - (28 Jan 2025)
The Committee divided: - Ayes: 5 / Noes: 8 - Question accordingly negatived.
The Committee divided: - Ayes: 4 / Noes: 8 - Question accordingly negatived.
The Chair
With this it will be convenient to discuss the following:
Clause 127 stand part.
Schedule 16.
Gregory Stafford (Farnham and Bordon) (Con)
It is a pleasure to serve under your chairmanship this morning, Mr Pritchard.
Clauses 126 and 127 and schedule 16 pertain to audiovisual and radio broadcasting restrictions on tobacco, vapes and the related products that we have been discussing endlessly in this Committee. Although there is a strong argument for the measures from a public health perspective, there may be legitimate concerns regarding freedom of expression and the impact on broadcasters and advertisers —I may be pre-empting points my hon. Friend the Member for Windsor will raise.
One of the most compelling arguments for the clauses is their role in protecting young people from exposure to tobacco and vaping products. Studies have consistently shown that advertising plays a significant role in influencing smoking and vaping initiation. Research from Cancer Research UK indicates that young people who are exposed to tobacco advertising are more likely to start smoking, and similar findings have been observed with vaping products, where targeted marketing strategies have contributed to a rise in e-cigarette use among teenagers.
By restricting tobacco and vape-related advertisements on television, radio and on-demand services, the clauses aim to reduce the normalisation of smoking and vaping. The UK has already seen the benefits of such measures in relation to tobacco: since the implementation of the Tobacco Advertising and Promotion Act 2002, smoking rates have declined significantly. Extending similar restrictions to vaping is the logical next step to ensure that history does not repeat itself, with a new generation becoming dependent on nicotine.
Critics might argue that the clauses may have unintended consequences for broadcasters, advertisers and the creative industries. The sector relies heavily on advertising revenue, and restrictions on tobacco and vaping-related content may limit potential funding sources, particularly for smaller, independent broadcasters, in an already challenging economic environment. However, as we have seen with the existing bans in relation to tobacco, the public health benefits clearly outweigh the potential issues with the funding that broadcasters could get from vape advertisements.
There is a practical consideration about how the clauses are enforced. We must ensure that broadcasters and on-demand services comply with the new restrictions, and that will require regulatory and oversight resources. Perhaps the Minister could give us some idea of how the provision will be enforced, whether that is through Ofcom or some other means. There is also a concern about what I describe as cross-border broadcasting. Many streaming services operate internationally, so content produced abroad but accessible in the UK may not be subject to the same restrictions, and if it is, ensuring compliance with UK regulations on the global platforms will present a significant challenge. How does the Minister intend to enforce the provisions in those cases?
This is a complex issue and a balanced approach is necessary, but as I have said, investing in public health campaigns alongside the regulatory measures could help to ensure that the public receive accurate information about smoking and vaping. I therefore support the clauses.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I support the clauses too, although I have a couple of questions. I hope the Minister will be so kind as to answer them.
Clause 126 outlines that part 6 does not apply to independent television or radio services, services provided by the BBC or Sianel Pedwar Cymru, on-demand programme services, or non-UK on-demand programme services that are tier 1 services as defined in the Communications Act 2003. Essentially, they will be covered by Ofcom. Paragraphs (a) and (b) specify exclusions for independent television and radio services regulated by Ofcom, provided they are not classified as additional services. Will the Minister clarify how additional television services and digital additional sound services are defined in practice, and what criteria will be used to classify services at the margins of those categories?
The clause exempts services that are defined as on- demand services under section 368A of the Communications Act from provisions of the Bill. In the rapidly evolving digital media landscape, does the Minister believe that the definition of an on-demand programme service is sufficiently clear to encompass emerging service models? Given the rapid growth of online platform streaming services and the desire he previously expressed to future-proof the bill, does he foresee current exclusions in clause 126 remaining relevant in the future? Should how these platforms, whether UK or non-UK based, are regulated be reconsidered, to ensure they adhere to the same standards as traditional broadcast media in relation to tobacco and vapes while being viewed in the UK? We keep coming to this point—how online services can be used to circumvent measures of the Bill.
Gregory Stafford
My hon. Friend makes a good point, raised in a number of our debates, about future-proofing the Bill. There is a big discussion going on about artificial intelligence and how that plays in. I do not know whether my hon. Friend has thought about that, or whether the Minister can clarify how artificial intelligence may be used by the tobacco and vaping industry to get round some of the provisions, and whether the future-proofing is strong enough to deal with that.
Dr Johnson
I know my hon. Friend is very interested in AI. I am sure that if it is possible to do so, these industries will use any means available to them to maintain their market.
The clause extends the regulations from tobacco to cover all vaping products, herbal smoking products, cigarette papers and nicotine products. Given my concerns about children and vaping and the use of nicotine, I think this is a sensible measure, which I support.
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
It is a pleasure to serve under your chairmanship, Mr Pritchard. Clauses 126 and 127 and schedule 16 contain provisions relating to audiovisual services and radio broadcasting. Clause 126 provides that part 6, which deals with advertising and sponsorship, does not apply to certain categories of television and radio service. That is because these services are already prohibited under the Communications Act 2003.
Clause 127 introduces schedule 16, which amends the Communications Act 2003. The amendments extend provisions in that Act that ban advertising and sponsorship of tobacco products in certain TV and radio services to include herbal smoking products, cigarette papers, vaping products or nicotine products. That ensures that the advertising ban on tobacco in television, radio and on-demand programme services is extended to all of those products. In practice, the measure means we will no longer see banned products or promotional material for those products on any of those mediums.
The shadow Minister rightly points out that the services listed in the clause include ITV, independent television and radio, the BBC and Sianel Pedwar Cymru, and on-demand programme services—that covers the points that Members have made—and non-UK on-demand programme services, which are tier 1 services as defined in the Communications Act 2003. I hope that reassures the hon. Member for Farnham and Bordon that it also includes programmes produced and aired outside the United Kingdom that are brought into the United Kingdom.
As a helpful aide-mémoire for the Committee, the Communications Act 2003 regulates telecommunications broadcasting. It confers functions on the Office of Communications, a regulator, to oversee the services. The Act puts in place effective rules for the advertising of tobacco on television, radio and on-demand services. By amending the Act, we ensure that this existing framework also applies to vaping products, nicotine products, and cigarette and herbal smoking papers. There is no need to reinvent the wheel and add more to the Bill, as we can use the existing provisions in the 2003 Act. I therefore commend the clauses to the Committee.
Question put and agreed to.
Clause 126 accordingly ordered to stand part of the Bill.
Clause 127 ordered to stand part of the Bill.
Schedule 16 agreed to.
Clause 128 ordered to stand part of the Bill.
Clause 129
Enforcement authorities
Question proposed, That the clause stand part of the Bill.
Dr Johnson
The clause outlines the responsibilities and jurisdictions of enforcement authorities tasked with ensuring compliance with part 6, which covers advertising and sponsorship. Subsection (1) establishes that the enforcement authorities are legally bound to enforce the provisions of the Bill, and subsection (2) contains the definition of an “enforcement authority”. All that sounds very straightforward and sensible, but my question is about funding. If the weights and measures authorities are given an obligation to enforce something but not given the resources to enforce it, they are being given a legal obligation with which they have not got the resources to comply.
Paragraphs 613 and 614 of the impact assessment state that the average trading standards service, of which there are 197, has 9.4 full-time equivalent professionally qualified staff. It is assumed that all those staff would need to be familiarised with the policies and all the various regulations once they are passed through Parliament. We have talked about the amount of regulations that will be created under the Bill; staff will need to be trained in all that. In 2024, the cost of such training was estimated at £23,137, but given that the Bill will not come into force until later—we are in 2025 now—that is a moot point. How much does the Minister think training will cost once all the regulations are up and running? Clause after clause of the Bill provides for regulations to be made, which may be done in one go or several, repeating the need for training.
The impact assessment also talks about the cost of training for the Advertising Standards Authority, estimating it to be £1,945. If it costs that to train all the staff from the ASA on a given topic, it suggests the rest of the public sector’s training could definitely be made more efficient. I suggest that the Minister has a chat with the Chancellor about it—I believe she is looking for ways to make the country more efficient, which she has done so far by making businesses not exist—as it seems a little out of kilter, although I was not sure whether it was a dot or a comma. The impact assessment also measures what it believes Ofcom would need to enforce the training under the new measures. It estimates £3,500 for the staff there, but again, does the Minister think that is realistic?
Clause 130 is about the power of Ministers to take over enforcement functions in a specific case. We have talked at some length in previous debates about the potential for abuse of power in such measures. Clause 131, similarly, is about the power of Ministers to take over proceedings as part of the enforcement functions in respect of a specific case. Again, while I can understand the Minister’s desire to be able to take over from a weights and measures authority as a whole if there were to be a problem with the way it was functioning in a specific case, can he give assurances that there would not be any abuse of power in that respect?
Andrew Gwynne
I thank the shadow Minister for her questions. The Government are investing over £100 million over five years to boost His Majesty’s Revenue and Customs and Border Force’s enforcement capability to tackle illicit tobacco. In 2025-26 we will invest £30 million of new funding for enforcement agencies, including trading standards, Border Force and HMRC, to tackle illicit and under-age sales of tobacco and vapes, supporting them to implement the Bill.
Decisions on funding for trading standards in future years will be made as part of the spending review process, but given our clear commitment to enforcement in the Bill and the fact that we have put down the payment of £30 million for enforcement in the next financial year, I hope hon. Members are assured that we take these matters seriously. We are investing £3 million over two years specifically to enhance the work led by National Trading Standards to tackle under-age and illicit vape sales. That work is carried out through enhancing market surveillance and enforcement action on ports, online sales enforcement, and boosting the storage and disposal of illicit vapes. The new funding for 2025-26 will build on this work to tackle under-age and illicit vape sales.
The shadow Minister asked how trading standards will use their additional enforcement funding. The crucial point is that we want to boost trading standards’ capacity, to enable the services to conduct more under-age sales test purchases, remove illicit products from the market and identify non-compliant products and bring them into compliance where possible.
Dr Johnson
My question was not simply how trading standards will use the money allocated, but whether the Minister feels that the money he has allocated is adequately purposed?
Andrew Gwynne
I do, which I have just said. The £30 million in the next financial year to boost the enforcement agencies will meet the needs that the Bill sets out. It is also about boots on the ground and having greater capacity. We will be working with trading standards on this additional enforcement funding to ensure that they increase their capacity and are able to take on the roles and responsibilities that the Bill places on them. We will continue to discuss with trading standards how we can best support them in respect of the measures of the Bill. I commend the measures to the Committee.
Question put and agreed to.
Clause 129 accordingly ordered to stand part of the Bill.
Clauses 130 to 132 ordered to stand part of the Bill.
Clause 133
Power to extend Part 6 and Communications Act 2003 to other products
Question proposed, That the clause stand part of the Bill.
Dr Johnson
Clause 133 gives the Secretary of State the power to extend part 6, which deals with advertising and sponsorship, and the Communications Act 2003 to other products, specifically products that are devices of a specified description enabling a tobacco product to be consumed, such as a heated tobacco device or pipe, or an item that is intended to form part of such a device. It allows the Secretary of State to consult with the required persons and gain consent where required with the devolved legislatures. However, how will the Secretary of State further define that, and can the Minister give us some examples of the types of products that might be included under the power? Could it allow for the expansion of regulation to a wide range of products not originally envisaged in the Bill?
The inclusion of devices and items potentially covers a wide array of consumer products without any clear boundary. What are the specific criteria or considerations that the Secretary of State must use when deciding whether to extend the provisions? Could that lead to arbitrary or inconsistent decision making, depending on the political or public health priorities of the Government of the day? The wording seems to give considerable latitude, but not much clarity on when or how the Secretary of State should exercise the power.
Andrew Gwynne
I am very happy to answer the question posed by the shadow Minister. It is a simple answer: we need clause 133 to avoid loopholes. Otherwise, newer products such as heated tobacco—and those products that have not even been developed yet—are in scope of the restrictions, but devices used alongside them could still be used to promote tobacco consumption.
Question put and agreed to.
Clause 133 accordingly ordered to stand part of the Bill.
Clauses 134 and 135 ordered to stand part of the Bill.
Clause 136
Addition of smoke-free places in England
Jim Dickson (Dartford) (Lab)
I beg to move amendmentusb 11, in clause 136, page 77, line 8, after “regulations” insert
“and a local authority may (as respects its area) make byelaws”.
This amendment would extend the power to designate areas as smoke-free to certain local authorities, by making byelaws. Any byelaws so made would need to be confirmed by the Secretary of State by virtue of section 236 of the Local Government Act 1972.
The Chair
With this it will be convenient to discuss the following:
Amendment 12, in clause 136, page 77, line 14, after “regulations” insert “or byelaws”.
This amendment is associated with amendment 11.
Amendment 13, in clause 136, page 77, line 16, after “regulations” insert “or byelaws”.
This amendment is associated with amendment 11.
Amendment 14, in clause 136, page 77, at the end of line 24, insert—
“(5) Before making byelaws under this section the local authority must consult any persons the local authority considers it appropriate to consult.
(6) In this section,
‘local authority’ means a county council in England, a district council, a London borough council, the Common Council of the City of London in its capacity as a local authority, the Council of the Isles of Scilly, a combined authority or a combined country authority.”
This amendment is associated with amendment 11.
Jim Dickson
It is a pleasure to serve under your chairship, Mr Pritchard. Amendments 11 to 14 are intended to extend the power to local authorities in England to designate areas as smoke-free by making byelaws. Any byelaws would need to be confirmed by the Secretary of State, by virtue of section 236 of the Local Government Act 1972.What the amendments seek to do is to bring the power to extend smoke-free places to a local level, as there are already a number of local authorities that have had success with that approach.
As we know, local authorities are responsible for public health and know their communities well. Eleven councils have introduced 100% smoke-free conditions in pavement seating, including in thriving cities such as Liverpool, Manchester and Newcastle. There are many more areas where that approach could have benefits: for instance, in my Dartford constituency, we have a high street with an area where an excellent market takes place every Thursday and Saturday. It is an area not covered by smoke-free legislation, but one that in my view could greatly benefit from smoke-free areas.
Gregory Stafford
We may come on to this point when we discuss the substantive part of clause 136, but does the hon. Member not see any potential difficulty where there are different local authorities with different regulations on smoke-free areas? One of the beneficial simplicities in the Bill is that it applies the same rules across all areas in all the different constituent parts of the United Kingdom. What he is suggesting could potentially add a level of complexity.
Jim Dickson
That is indeed a good question. Consistency is clearly desirable: it is easier for the public to understand and it makes enforcement easier. However, there are councils already leading the way in that area, and it is a question of the needs of the community covered by that local authority. We know that smoking is particularly concentrated in deprived communities. Local authorities are able to understand what areas are most at risk, work with those communities and arrive at solutions hand in hand with them. We know that public spaces facilitate quit attempts, so it is a great way to do this in areas where the communities consent to that approach. I still advocate the measure as a good way forward.
Obviously I would have liked to have seen outdoor hospitality settings included in the consultation for smoke-free extensions to this Bill; however, I know that many Members at the Second Reading expressed relief that that is not in scope for England. Other Members have sought to put the areas identified by the Government on the face of the Bill to rule this out in future, but I disagree with that approach, because we need flexibility.
Gregory Stafford
This is a point I will raise with the Minister as well—just to forewarn him—but, whereas I entirely agree with the future-proofing of this Bill in areas such as products and advertising where the market may move on, I do not fully understand why the regulations need to be so open on public places. Public places are not going to change over the next 100 years, so why not define them on the face of the Bill?
Jim Dickson
Certainly, public spaces are not going to change, but smoking prevalence is; it may be that as, a result of declines in smoking prevalence, the public acceptance of smoke-free areas may change. I am sure that the Minister will have a useful contribution to make in response to the hon. Gentleman’s point when he speaks. There is a discussion to be had.
I would be particularly interested to look at the data and modelling and the customer feedback that suggests that hospitality venues are economically dependent on the consumption of tobacco. As we have discussed, currently only 11% of the population smoke—granted, if we are talking about nightlife, that prevalence may be higher, but I certainly believe that families should be able to enjoy eating outside in the summer without being exposed to the risk of second-hand smoke. We have seen that smoke-free pavement licences are popular with businesses and with the public, particularly families with children.
Giving local authorities a say in how smoke-free laws are applied will align with the commitment in the recent English Devolution White Paper to shift any power
“away from Whitehall and into the hands of those who know their communities best”.
It is critical that local authorities consult fully on any measures, and particularly closely with the hospitality industry. As I say, there is a possibility that that industry, in specific parts of local authorities where the consultation takes place, may actually agree and feel that this is a sensible step. It is important that local authorities get this right with the right consultation, but they should have the powers to do it.
The Chair
I remind Members that we are at this point talking about amendments, so any comments should be restricted to those amendments. We can talk about the generalities of the clause later in the debate. It is always helpful to have a reminder of that—for myself as well.
Dr Johnson
I thank the hon. Member for Dartford for clearly laying out what he seeks to do. I understand that his desire to see a healthy population is driving his good intentions behind this amendment, but I have some concerns. We are creating an offence of smoking in specific places: that requires buy-in from the public, because we police with consent, and the public need that knowledge. I visit Newcastle a reasonable amount, and I did not know that there was a rule banning smoking on park benches. I do not smoke, so it did not apply to me in any case, but it is conceivable that others are not aware that Newcastle has local rules.
I am concerned about the consistency of such measures and about people’s awareness of where it is possible to do something; otherwise, we will create criminal offences and fine people large amounts of money for doing something they had no reason to prevent themselves from doing because they had no way of knowing. The Government are also in the midst of reorganising —or trying to reorganise—all the local authorities; if local authorities are going to make such decisions and then be reorganised, that could further add to complexity and confusion for the public.
For people who smoke, we want to limit the harms to their health and ensure they have the opportunity to quit or to minimise those harms. Not everybody has a garden or outside space of their own. If they live in a flat and are a smoker, only being able to smoke in that flat because all the outside spaces are gone will increase the dangers to them, for health and for other reasons. My personal opinion is that these laws, or at least the principle of which spaces may and may not count, should be made nationally—even if there is some local guidance to be followed.
That is why we will come to the principle of which sort of spaces, because at the moment it is any space. It is conceivable therefore that, under the hon. Gentleman’s amendment, a group of local councils could decide to make all outdoor spaces of all kinds smoke-free. While I would find that desirable as a non-smoker, it would not be good for the overall health of the 11% of people who do smoke.
Gregory Stafford
Looking at the amendments, I can see why the hon. Member for Dartford wants to do this. There clearly could be public health benefits and, as a localist myself, I am naturally sympathetic to having local decisions made as close to people as possible. I think the point I made during the intervention stands, however: the potential for confusion among people who are potentially not from the area, or who are from the area but do not understand the local byelaws, probably makes the amendments unworkable.
My hon. Friend the shadow Minister and the hon. Member for Dartford mentioned that smoking prevalence is higher in places of social deprivation. The hon. Member seemed to be suggesting it would therefore be better to enforce regulations, or byelaws for regulations, in those areas. I can see the public health impact, but we must not ghettoise people who are from lower socio-economic backgrounds and who are more likely to smoke, as seen in the evidence. The shadow Minister makes a good point that people who do not have outside space, and who may have children and not want to smoke and vape in their properties because they are rightly worrying about their children’s health, will find that difficult if there are local byelaws in place that prevent it. I think that is especially true with women who smoke.
Jim Dickson
I thank the hon. Gentleman for giving way. He is making a number of very good points, but will he respond to the notion that smoke-free areas are all about making smoking less attractive and so giving people incentives to quit? Does he accept that that might give people incentives to quit and therefore be a significant public health benefit, and worth considering as part of the legislation?
Gregory Stafford
I completely agree that we could very easily ban tobacco and vaping for everybody at every age. That would be the biggest incentive for people to quit. The Government—I think rightly—are not doing that, because they are not looking to criminalise people who are currently addicted to tobacco and vapes. If we are allowing people to do something legally, there should be places where they can do so safely and not harm others, such as their own children. I am sympathetic to the public health argument that the hon. Gentleman makes but, in practical terms, there may be areas where this is a problem.
My final point is really a question for the hon. Gentleman: under what regulations would the local authority be enforcing such byelaws? Would it be through the penalties and enforcement activities in this Act itself —if it becomes law—or would there be some sort of fine or penalty system that the local authority could use? While there are potential fines and enforcement activities on the face of this Bill, if there were local regulations, would these be in line with what is in the Bill, or would there be some other fining system that a local authority could dream up itself?
Sarah Bool (South Northamptonshire) (Con)
Taking on board what you said, Mr Pritchard, I just want to build on the point that my hon. Friend made about enforcement—I always talk about enforcement in practice. I want to know how rules will be advertised between different jurisdictions. I think we will end up spending an inordinate amount of money on trying to run a campaign that could have been better spent on helping with smoking cessation or on more practical measures.
Dr Johnson
My hon. Friend is talking about the enforcement and practicalities of such a move. If we have a national campaign and national uniformity about the areas in which one can and cannot smoke, that will be quite straightforward for people to understand and there will be no real excuses for breaking the rules. If the advertising has to be done locally, it will have to be continuous to reach all the visitors and tourists who come to that town or city.
Sarah Bool
I absolutely agree, and my hon. Friend makes a powerful point. I would like us to consider this issue when we look at whether to take these proposals any further. I cannot see how we can ensure in practice that everyone knows what is happening without there being a national campaign.
Jim Dickson
Perhaps I can try to answer a couple of the questions from the hon. Lady and other hon. Members. If a byelaw were enacted, it would need to be well publicised, and there would need to be signage. Clearly, it would be impossible for a local authority to enforce a byelaw against which the defence was, “We had no knowledge of the fact that there was a byelaw.” Therefore, doing those things would be very important, and that would obviously be part of the consultation. The local authority would also have to set out a plan, and it would ultimately have to be approved by the Secretary of State, who I am sure would ensure that it was adequate. In terms of the penalties, the local authority has the power to set out its own penalties, but only within the quite tight legal framework set out in the Local Government Act. It would be for the local authority in this instance to define the level of penalty and what was proportionate.
Sarah Bool
I thank the hon. Member for clarifying that point. Many Members would prefer that local councils were dealing with potholes rather than advertising those different spaces, but I thank him for his amendment and his proposal.
Dr Johnson
Amendment 14 defines a local authority as
“a county council…a district council, a London borough council, the Common Council of the City of London in its capacity as a local authority, the Council of the Isles of Scilly, a combined authority or a combined country authority.”
By the time we get to next summer, Lincolnshire will probably have district councils, a county council and a mayoral authority—I do not agree with having a mayoral authority, because I think that is too many tiers of government, but that is an aside. What if those authorities do not agree? If we give them all the power to make regulations, they could all make different regulations based on different opinions—as is currently the case in Lincolnshire, the various authorities are not always under the control of the same political party.
Andrew Gwynne
I am grateful to my hon. Friend the Member for Dartford for bringing this issue before the Committee. As we have heard, amendment 11 would introduce a power for local authorities to make byelaws relating to the designation of additional smoke-free places in England, which would sit alongside the Secretary of State’s power to make regulations in the same regard.
As we know, the Bill expands the Secretary of State’s powers to create additional smoke-free places at the national level. In England, the Government have already indicated that we intend to extend the smoke-free designation to outdoor places including children’s playgrounds and outside schools and hospitals, but not to outdoor hospitality settings or wider open spaces such as beaches. The reforms we are setting out in the Bill will be subject to full consultation, and we want to hear the views of people from across the country to ensure that we get them right.
As drafted, the Bill gives no additional powers to local authorities. However, they have existing mechanisms for designating certain spaces as smoke-free. As we have heard, areas such as Manchester, my home city, have already used pavement licensing provisions to ensure that people have smoke-free options when they consume food and drink in certain locations, and that works well. Some local authorities have implemented public space protection orders to prohibit smoking in certain areas. For example, the London borough of Enfield has used a public spaces protection order to restrict smoking within the boundaries of children’s playgrounds. Of course, that will be obsolete should the consultation for the national scheme extend to children’s playgrounds, as we intend it to.
Dr Caroline Johnson
I thank the Minister for making those interesting points. Can he clarify whether powers such as those enacted in Enfield create a criminal offence?
Andrew Gwynne
We want to ensure that people who are smokers are not criminalised. Public space protection orders do potentially go down the criminal route. We want to ensure that that is not the case, which is why the Enfield scheme would of course be obsolete under the later provisions—which we are going to discuss today, hopefully—in relation to extending national outdoor smoke-free places.
Dr Danny Chambers (Winchester) (LD)
It is reassuring to hear the Minister talk about consulting before bringing in smoke-free places in specific public outdoor areas. Personally, as a non-smoker and someone who is very concerned about the public health impacts of passive smoking, I think we must also be mindful of the need for evidence-based interventions, and of the trade-offs. A good example is that of some fantastic pubs around Winchester and the Meon valley that have maybe two beer gardens, one to the side and one to the back. There would genuinely be no public health risk if smoking was permitted in one of the beer gardens and not the other.
The Liberal Democrats want reassurance on that. One of the reasons we tabled our amendment to clause 136, which is coming up, is simply to get assurances that the hospitality sector will not be impacted by any of these decisions, especially if the public health benefits are negligible.
The Chair
Order. We will discuss the specifics of the hon. Gentleman’s amendment when he moves it.
Andrew Gwynne
I suspect we are straying off the measures before us, Mr Pritchard, but I assure the hon. Gentleman that consultation is a statutory duty in this Bill. Were the Secretary of State, or indeed Welsh, Northern Irish or Scottish Ministers, to seek to change the scope in the future, they would have a duty at every stage to consult further. I hope that reassures the hon. Gentleman.
I was talking about Enfield and its public spaces protection orders. It is of course for the local authority to determine whether a PSPO is appropriate and that the legal test for implementing a PSPO is met, along with completion of the relevant consultation requirements. Nottingham has created a voluntary smoke-free zone at events, especially those where children are present, and it introduced a smoke-free play park policy in 2015. Other local authorities, such as Oxfordshire county council, have introduced voluntary smoke-free school gates policies. Given the options already available to local authorities and the national reforms introduced through this Bill, which we will debate further, neither the Government nor I think it is necessary to grant these byelaw-making powers via the Bill.
In answer to a point that the shadow Minister raised, which I hope to answer for my hon. Friend the Member for Dartford, legislation sets out all the different types of local authority. Enforcement in terms of the requirement to police any changes would appertain to the particular local authority, because it would be on that local authority’s land that the measures would apply. For example, in a two-tier area, if the county council as the highways authority deemed that pavement licensing were to be introduced, it would be for the county council to enforce its own measures; if a district council brought in measures in a park for which it was responsible, it would be for the district council. I think that is quite a simple explanation.
I understand that we have a complex jigsaw of local government, but it is for the particular type of council or authority that introduces a measure to enforce it. For example, the pavement licence in the City of Manchester is for the City of Manchester to enforce—not Andy Burnham as the Mayor of Greater Manchester, or indeed the Greater Manchester combined authority. That is pretty simple.
Dr Johnson
My question was not so much about the enforcement, which is defined in the Bill as the local weights and measures authority. Amendment 11 says that a local authority may make byelaws. The local authority that may make these byelaws includes the whole range of county councils, district councils and combined authorities, implying that, whoever is enforcing it, those that could make a byelaw could overlap and have contrary views.
Andrew Gwynne
Obviously, if a local authority introduces byelaws, as the City of Manchester has done in respect of pavement licensing, it is for that local authority to ensure that those byelaws are adhered to. Of course, in that case, the weights and measures authority is the City of Manchester, so I suppose that makes it easier.
These powers are already being used. Local authorities are already designating areas, whether it is for pavement licences, public space protection orders or just deeming that land within their own responsibility is smoke-free. We do not believe that the amendments are necessary. I kindly ask my hon. Friend the Member for Dartford to withdraw them.
Jim Dickson
The Minister has given a very comprehensive response. I suspect that the suggestion that this might be a way forward might come up in the consultation when that happens in the coming months. For the moment, I beg to ask leave to withdraw the amendment.
The Chair
No. Okay. That is fantastic. No problem. [Interruption.] I mean it is fantastic and we can hear you on another clause or amendment, just to be clear.
Amendment, by leave, withdrawn.
Dr Chambers
I beg to move amendment 4, in clause 136, page 77, line 8, leave out from “smoke-free” to the end of line 15 and insert—
“a place in England that is—
(a) an NHS property or hospital building,
(b) a school, college or higher education premises,
(c) a children’s play area or playground,
including outdoor public areas and frontages adjoining or surrounding such premises or designated areas.”.
This amendment would specify which places the Secretary of State has power to designate as additional smoke-free places in England on the face of the Bill.
The Chair
With this it will be convenient to discuss the following:
Amendment 95, in clause 136, page 77, line 12 at end insert—
“The Secretary of State may only make regulations designating external or open spaces as smoke-free in England outside—
(a) an NHS property or hospital building,
(b) a children’s playground, or
(c) a nursery, school, college or higher education premises.”.
This amendment restricts the Secretary of State to only being able to designate open or unenclosed spaces outside a hospital, children’s playground, school or nursery.
Amendment 94, in clause 136, page 77, line 21, at end insert—
“The Secretary of State may designate a place or description of place under this section only if in the Secretary of State's opinion there is a significant risk that, without a designation, persons present there would be exposed to significant quantities of smoke.”.
This amendment would re-instate existing section 4(3) in the Health Act 2006.
Dr Chambers
It is a pleasure to serve under your chairmanship, Mr Pritchard. To reiterate what I said before, the Liberal Democrats’ aim is to avoid unintended consequences that really damage the hospitality industry that we totally support. Amendment 4 would limit the places where we ban smoking or designate smoke-free to an NHS property or hospital building, a school, college or higher education premises, and a children’s playground or play area. We are not against public health measures; we are trying to ensure that we do not end up with provisions that are a bit over the top and damage hospitality businesses.
Dr Johnson
I shall speak to amendments 95 and 94, which stand in my name. Amendment 95 is similar to the amendment moved by the hon. Member for Dartford a few minutes ago. Members will remember that earlier in the summer the Labour Government suggested that they would include hospitality venues within the scope of outside spaces, which led to pushback from a number of sources, mostly the hospitality industry. Speaking to Sky News on 5 November, the Secretary of State said that it was
“a leak of a Government discussion”,
but that it had promoted
“a really good debate about whether or not it would be proportionate”.
He then said:
“I think people know that the UK hospitality industry has taken a battering in recent years—”.
I agree with the Secretary of State on that. Covid-19 certainly challenged the hospitality industry. The previous Government supported it through business loans, reduced taxation and furlough schemes. Now, just as the industry is getting back on its feet, this Government have battered hospitality providers by raising national insurance contributions, increasing the minimum wage for young people, increasing business rates, introducing the deposit return scheme, and nearly doubling business rates for small businesses. They are indeed taking a battering; we can agree on that. In that Sky News interview, the Secretary of State also said:
“we do not want to add to their pressures, so we are not proposing to go ahead with an outdoor hospitality ban at this time”.
That was in November, but does he still mean it now? How will we know?
The challenge of this clause is trust. The Prime Minister has talked about trust. Before the general election, the current Secretary of State for Environment, Food and Rural Affairs said, at the Country Land and Business Association conference, that Labour had no intention of changing the rules on agricultural property relief—but they have. The Government’s manifesto said that they would not increase national insurance on working people —but they have. On 11 June, Rachel Reeves told the Financial Times that she had no plans to increase capital gains tax—but she did. Labour said that it would not make changes to pensioner benefits, but then removed the winter fuel allowance. So there is no trusting that this Government will do what they say they are going to do and not do what they explicitly say they will not. I hope the Minister understands my reasoning.
It is interesting that the Liberal Democrats have a similar amendment to the Conservative amendment on this topic. As I said before, people need some form of open space and not everyone has a garden. There is some confusion about hospitality venues. For example, some pubs have a kids’ play area; will that be treated as a play area within the scope of the regulations, or will it be a hospitality area? Under the current statement, the Secretary of State will not include play areas, but the powers under the clause, which we will come to as a whole, give wide scope for the Minister and the Secretary of State to designate virtually anywhere as smoke-free, with criminal sanction for those smoking or vaping. The Minister and the Secretary of State have said that their only intention is to use these policies for NHS properties, hospital buildings, children’s play areas and education facilities. This being the case, I cannot see why the Minister would not be happy to have that on the face of the Bill. It is the stated intent. I am sure the Government will understand my point about trust.
There are a few minor differences between the Liberal Democrat amendment 4 and the Conservative amendment, mainly in that the Conservative amendment includes nurseries and the Liberal Democrat amendment defines play areas and playgrounds, as opposed to simply playgrounds. These are relatively small differences other than the addition of nurseries, which is beneficial that is where the smallest children are. Clearly smoking in a nursery school is an antisocial behaviour, so it would make sense for them to be included.
Amendment 94 states that:
“The Secretary of State may designate a place or description of place under this section only if in the Secretary of State's opinion there is a significant risk that, without a designation, persons present there would be exposed to significant quantities of smoke.”
The Health Act 2006 states that the Secretary of State has to be clear, in his own mind, that there is a risk of high levels of smoke if he is going to ban smoking, so it is a measure of proportionality. Smoking in an outdoor space, miles from anywhere with nobody about, exposes no one but the smoker, making it slightly safer to smoke outside than inside for both the smoker and the people around them.
Why did the Minister choose to remove the “significant smoke” measure from the legislation? Does he feel that there is no significant amount of smoke to be inhaled by somebody who is in an outdoor space with somebody else? What is the chief medical officer’s advice on the amount of smoke that is likely to be inhaled by someone in an outdoor space alongside or nearby someone who is smoking? I understand that there will be a duration issue—how long the person is sat there, how long the smoker is smoking for and how many cigarettes they have, how close the person is and how windy it is—but will the Minister explain why he chose to remove that measure?
Gregory Stafford
I agree with my hon. Friend the shadow Minister. It seems strange that the Government want to have such wide-ranging powers in this area. Unlike other parts of the Bill, where technologies and such may move on and where I appreciate the need to future-proof, here it is very clear. I do not think that at some point in the future we will believe that smoking in playgrounds, or smoking in a field with nobody else around, are better or worse than they are now.
I have a lot of sympathy for the Liberal Democrats’ amendment 4 and our amendment 95. As my hon. Friend pointed out, the amendments are relatively similar, if not word for word the same. It almost takes us back to coalition days in 2010—let us hope that does not happen too often—and shows that His Majesty’s Official Opposition and the Liberal Democrats have significant concerns. While the Minister and his colleagues have said that they will not extend a smoking and vapes ban to hospitality venues, there is a lack of trust on our part, because even if it is not in the current Minister or Secretary of State’s mind, a future Secretary of State may be minded to put such a ban in place. That is why the amendments tightly define exactly where the smoke-free areas could be.
It is obvious that we do not want people smoking in children’s playgrounds, nurseries, schools or higher education premises. We have had some debate about this on other clauses, but I personally believe that we should not be smoking in NHS properties either. None the less, to return to a point I made previously, if we are going to permit people to do something within the law—people born before 1 January 2009 if we are talking about smoking and everybody over the age of 18 if we are talking about vaping—they must have somewhere safe to be able to do it.
The point of the clause is to address the impact of smoking and vaping on others. I take the shadow Minister’s point that clearly, if someone is smoking in a playground, it will have a greater impact on other people than if they are standing in the middle of a park or field with nobody else around. There needs to be an element of proportionality. As the shadow Minister and the hon. Member for Winchester said, we do not want to do anything that could harm our already stretched hospitality industry, which is under extreme pressure. If the Minister or Secretary of State were minded to start imposing bans in hospitality, that would have a significant impact on the hospitality business. I support the two amendments.
Dr Beccy Cooper (Worthing West) (Lab)
This is an interesting debate, and I want to add some thoughts from a public health point of view. There is a balance to be struck in Government between supporting the hospitality industry and making sure that we are being fair and proportionate and encouraging businesses. We should also be mindful of public health evidence about passive smoking in an area—for instance, outside a pub where there are multiple people and some are passive smoking. It is clear that the Government, the current Secretary of State and our Minister have taken the proportionate response that the law will not extend to public spaces with hospitality. We should be mindful, however, that history does play out in public health and that people’s attitudes about what is acceptable does change. Therefore, leaving this issue open to allow that debate to continue within our political sphere is absolutely fair and proportionate.
Gregory Stafford
The hon. Lady makes a very good point, but it is almost one that supports mine—although she said she believed that the current statements from the Government are proportionate, I can already hear in her voice that actually, she would like to see this provision extended to those areas.
Dr Cooper
The hon. Gentleman raises a fair point. I am perhaps a public health consultant first and foremost and a politician second, but I do appreciate that in politics, we have to find fairness and balance and support people in their businesses, as well as being mindful of their health. As a public health consultant, I am looking at people’s health first and foremost, but I think this is the right place in Government to have this sort of legislation and this debate, so I am supportive of what is in the Bill. It is for people like me to make the argument that passive smoking outside hospitality, for example, is not the way forward, but as a politician, I absolutely appreciate that I have to be mindful of businesses. I therefore maintain that the proposals are balanced, but I take the hon. Gentleman’s point that I am a public health consultant, and I declare that as an interest.
Gregory Stafford
I thank the hon. Lady for her clarification. I have great respect for her public health abilities and knowledge. I accept the points that she made, but Opposition Members feel that including in the Bill areas that will potentially be consulted on being smoke-free is proportionate to ensure that there is not overreach. I know that if the amendments are accepted and, at a future point, attitudes and science change, she will be a doughty campaigner to have the law changed, and I am sure that she will achieve it, if that is the way she wants to go.
Dr Johnson
In response to what my hon. Friend and the hon. Lady the Member for Worthing West are saying, as a doctor, I have a lot of sympathy with her position. Certainly, if I take my children out for a meal in a restaurant and we sit outside in the summer, having a lovely day in the beer garden, and along comes a family or another group of people who sit and smoke, I dislike that. Whether it should be made illegal is a different matter, but it is something that I do not like.
As my hon. Friend said, there is a balance between enabling someone to do something that we have decided will be legal—that is, someone who is born in the right timeframe to be able to smoke—and giving them somewhere safe to do so. Over time, I suspect the measures that the Bill as a whole grants will lead to a reduction in smoking, which, of course, is its intention. As smoking becomes less prevalent, it is likely that smoking in front of children, particularly in outside hospitality spaces or in other places, will become less socially acceptable. We saw hospitality bring in non-smoking areas in the past.
The hon. Member for Winchester talked about having two different beer gardens in the same pub, one for smoking and one without. It is within the capacity of any given hospitality business to choose, as smoking becomes a minority and antisocial pastime, not to allow it within their facility, and to police that by throwing people out. It is also possible for individuals to choose not to attend a beer garden of a pub where smoking is allowed. To some extent, therefore, the ability of people to choose and vote with their feet, and the desire of the market and hospitality industries to maintain their custom, will surely have some effect on this over time.
Gregory Stafford
The shadow Minister is right. I do not want to stray into the main part of the clause, which we will come to, but one of the key reasons behind the Liberal Democrats’ amendment 4 and our amendment 95 is that we want to protect areas that may be negatively impacted from a business point of view, if the Government were to bring in restrictions on smoking in outdoor areas—and it is not just smoking, but smoking and vaping. I agree with the shadow Minister that if I go out with my children and sit in a pub beer garden or restaurant, I find it absolutely disgusting if there are people smoking around me. I generally vote with my feet, as I am sure other punters do, and do not go back to that pub or restaurant.
Mr Alex Barros-Curtis (Cardiff West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Pritchard. I rise to speak to amendments 4, 95 and 94; as they are very similar, my comments will apply in the generality. It is disappointing to hear the shadow Minister’s cynicism about the commitments made by the Minister at the Dispatch Box.
Mr Barros-Curtis
She may well have given a few examples—I can think of a litany of examples from the previous 14 years of Tory Government. However, that would stray from the amendments, and as we do not have the time, I will not indulge the Committee with that. But I would suggest that that cynicism is not merited because, as the Minister and his colleagues in the Department of Health and Social Care have shown in these sittings—
Gregory Stafford
I entirely agree with the shadow Minister’s point about broken promises from the Labour Government, but I do not think she was saying, and I certainly was not saying, that we currently hold any untoward view of the Minister or the Secretary of State. However, does the hon. Gentleman not agree that we do not know who the Secretary of State or the Minister might be in future Governments, and that they might not wish to be beholden to previous statements? That is why it is so important to make sure that we are clear about which open spaces we are talking about when we restrict people’s right to smoke and vape in them.
Mr Barros-Curtis
I am grateful for that intervention. I point the hon. Member to proposed new subsection (4), which reiterates that the Secretary of State “must consult” before any such regulations can be made. I am sure that will assuage his concerns about whoever the future Secretary of State may be, whether they are from this side of the House or, God forbid, the other side in a few decades’ time.
I will point out a couple of issues about the drafting of the amendments. Although I understand the position of Opposition Members, I think the proposals inadvertently cause issues and risk causing more confusion than may have been intended. For example, does
“an NHS property or hospital building”
include private healthcare providers that are undertaking NHS work either on NHS premises or off-site? What about subcontractors? When the amendment mentions
“a nursery, school, college or higher education premises”,
are we talking about where premises have had to be vacated because of the RAAC—reinforced autoclaved aerated concrete—crisis and where children are being taught in portacabins in a council car park, one or two miles away from the original site? These definitions are lacking and may inadvertently cause gaps in the application of the measures, if the amendments were successful. What about premises used for youth prisons? Should that be captured or not, given what was said about protecting children from the dangers of smoking?
Notwithstanding the fact that I understand the intention behind the amendments and what Opposition Members have said, I think the drafting may inadvertently cause issues and undermine what the Minister has said, both here and at the Dispatch Box, about the parameters in which this set of regulations would be brought in. Those would be underscored by consultation and the commitments that have been made at the Dispatch Box. Although I appreciate and understand hon. Members’ comments, I suggest that the amendments are not necessary, for the reasons I have outlined, and I would encourage them, if the amendments are not withdrawn, perhaps to vote against them if they are pushed to a Division.
Sarah Bool
I respect the points made by the hon. Member for Cardiff West, because I understand that we do not want any unintended consequences. However, I would counter that by saying that although we perhaps need better definitions—that may be something we can consider—clause 136, as drafted, is incredibly wide, and any of the assurances that have been given to hospitality are merely words. There is absolutely no carve-out for the hospitality sector as this stands.
As much as I think the Minister is honourable in his intentions, unfortunately, we all know that we can go only on the law in front of us in black and white, and there is currently no security for the hospitality sector in this regard. We need to be incredibly clear about this with the hospitality sector, and we need the exclusion. One of the bigger concerns is that if people are not able to smoke—perhaps in a pub garden—it will force them into their homes, where they are actually more likely to drink and smoke more because they are not within that limited capacity of being out in public. We have to think about what the dangers are. Are we actually forcing people to take up worse habits in their private residence than if we allow them a little bit of flexibility in an open space?
I have a question about NHS properties generally. I appreciate that we want smoke-free places and that one wants to go into hospital and walk past people smoking, but I worry about those who have an addiction. Where do they go if they need to smoke, as they would if they are going through a process of cessation? What ends up happening as a result of all these provisions is that the smokers will just be forced down the road away from the property, but that has not really addressed the issue. We have just pushed the problem a few metres away.
We need to think in the round about how we best achieve our aim, how we deal with addiction, and how we clean up the hospital environment in a balanced and proportionate way. Perhaps the Minister has some other ideas, but I do not like the idea of just pushing some smokers down the road, rather than dealing with the issue at hand.
Andrew Gwynne
I am grateful for our debate on amendments 4, 94 and 95. I am even more grateful that a lawyer, my hon. Friend the Member for Cardiff West, is sitting behind me—as a non-lawyer, I note that it is always good for somebody to have one on their side. Indeed, the hon. Member for South Northamptonshire is a lawyer as well; in matters of law, there are always disagreements.
Amendments 4 and 95 would remove the power in the Bill to extend smoke-free places to any area that is a workplace or open to the public, including outdoor spaces in England. That would be replaced with a limited power to extend smoke-free places only to healthcare and education settings and to playgrounds. Amendment 94 would reinstate the test present in the Health Act 2006, which requires, in the Secretary of State’s opinion, a significant risk of exposure to significant quantities of smoke before being able to designate an additional place as smoke-free.
On extending smoke-free places, as we heard from a range of public health experts, evidence for the harm from exposure to second-hand smoke is well established. People exposed to second-hand smoke are at increased risk of cancer, chronic respiratory disease and cardiovascular disease. The World Health Organisation estimates that, every year, second-hand smoke kills up to 1.3 million people worldwide.
The science tells us three things about second-hand smoking. First, it poses a risk to health even outdoors. Secondly, it is particularly dangerous for vulnerable people, including children, pregnant women and those with pre-existing but usually invisible health conditions, such as asthma and diabetes. Thirdly, in some public settings, exposure to second-hand smoke can be high. If you can smell it, you are inhaling it.
It is important that the powers are broad, so that the Bill is appropriately future-proofed, as we have discussed in relation to other measures in the Bill.
Gregory Stafford
The Minister may come to this, and I am sorry to keep banging on about it, but I do not understand the future-proofing element of the clause and, therefore, why he opposes our amendments. Unless we have colonised Mars, surely there will be no new definition of an open space, or new wonderful industry way of claiming there is one. We know what open spaces are, and they are not going to change, so what is the future-proofing element?
Andrew Gwynne
The future-proofing element is if the science changes or, more likely, that over time public attitudes change. Smoking is already a minority pastime, and we expect that, in 25 years’ time, the prevalence of smoking among those aged 30 or below will be near to zero, so we will want to protect people from the scourge of second-hand smoke in other places. But that is a debate for other Ministers in other Sessions of other Parliaments at some stage in the future.
I do not want to tie the hands of my successors, so that they have to find a slot before the House for primary legislation to make simple changes. A far more practical and workable mechanism is for my successors to be able to come to the House to say, “The evidence has changed”, or, “Public opinion has changed”, and, “We now seek to consult the outside world on introducing further areas under the powers in the Bill”, and then to lay secondary legislation following the statutory duty to consult. Other areas can therefore come within the scope of the Bill.
Sarah Bool
I take the Minister’s point, but there is only a requirement to consult, so actually, completely unlimited powers have been given to make this change. We are trying to argue that we want the spaces to be clearly defined. It is important and right that we should come back to Parliament to make a change at a future point, if we want to extend the Bill further. But that will only be consultation, based on the current drafting, and a change could be pushed through regardless. The Labour party says that it is trying to support and back hospitality, so making this absolutely clear on the face of the Bill at this point will give hospitality the reassurance that it needs. I cannot see why there is any objection to more clarity, rather than overarching and wide powers. We are binding the hands of future generations and telling them that they cannot smoke and cannot vape—that right has gone—and then, on the other hand, we are saying, “I cannot bind the hands of my future successors”. We need reassurance and clarity for hospitality, and that is not in the Bill.
Andrew Gwynne
I have at no stage said that Ministers would not come back to Parliament. What I have said is that we should not be seeking to find one of those rare things—a slot in a King’s Speech for primary legislation—for something as simple as consulting on further areas.
I also remind the hon. Lady that the powers in the Bill are UK-wide. They do not give just the Secretary of State, or me as the Public Health Minister, the powers to consult in relation to England; they give the same powers to the Scottish Health Minister, the Welsh Health Minister and the Northern Irish Health Minister to consult and to bring forward secondary legislation on extensions following that.
We have been absolutely clear that the Government intend, in relation to England, to consult on schools, hospitals and children’s playgrounds—nothing else. It is those three things. That is our intention. The level of detail will be subject to the consultation. If in the consultation it is deemed that the measure should be extended to other NHS facilities beyond hospitals or to nurseries as part of an education setting, that will be entirely a matter for the consultation, and secondary legislation will therefore be brought to this House. But it is our intention—I cannot make it any clearer—that the three areas this Government are going to consult on are hospitals, outside schools and children’s play areas. We are not going to consult on hospitality. That is clear.
My counterparts in other parts of the United Kingdom may well come to a different decision on which areas to consult on. They may not consult at all.
Gregory Stafford
I thank the Minister for his clarity about what he and the Secretary of State are going to consult on; I take him at his word, of course. But is he not now demonstrating the concerns that we have? Other parts of the United Kingdom will potentially consult on retail. Therefore, the amendment is absolutely necessary. Although I am an England Member of Parliament and care mostly about the good people of Farnham, Bordon, Haslemere, Liphook and the surrounding villages, I have a wider duty as a Member of Parliament to ensure that the hospitality businesses of the United Kingdom of Great Britain and Northern Ireland are protected. I am afraid that the Minister has really worried me with what he has just said.
Andrew Gwynne
I can speak only for England, but I am legislating for the United Kingdom with the permission of Health Ministers. It may well be that Health Ministers in other parts of the United Kingdom decide not to consult at all. In Wales, for example, they already have the coverage of all the areas that we are going to consult on in England.
The hon. Member for Farnham and Bordon says he is now even more worried. Well, I tell him this: worry not, because his amendment relates to England only. If he is so mithered about the rights of the Welsh to consult Welsh business on Welsh matters, he should have put Wales in his amendment. If he so bothered about the rights of the Scots to consult on Scottish matters with Scottish business, he should have put Scotland in his amendment. If he is so bothered about the rights of the Northern Irish to consult Northern Irish business about Northern Irish matters, he should have put Northern Ireland on the face of his amendment. He doth protest too much, Mr Pritchard!
The hon. Gentleman has actually made my case for why these measures are proportionate: they cover the whole of the United Kingdom and it will be down to Ministers in the respective parts of the United Kingdom to decide who they will consult, why they will consult and what areas they will consult on. But as far as England is concerned, I cannot be any clearer: hospitality is out of the scope of our consultation. We will consult on three things: hospitals, schools and play areas.
Dr Caroline Johnson
I thank the Minister for giving way, although I would point out that it was not my hon. Friend the Member for Farnham and Bordon’s amendment at all.
Dr Johnson
He is supporting it, but the Minister asked why my hon. Friend did not include things in it. The answer is that he did not write it. The amendments were written by others, one by the Liberal Democrats, and supported by him, which is not the same thing.
The Minister will no doubt have caused concern for the people in hospitality industries in Wales, Northern Ireland and Scotland who are following proceedings today. Could he tell the Committee a bit about the discussions he has had with his counterparts? Have any of them indicated to him their intent regarding hospitality areas in their designated parts of the United Kingdom?
Andrew Gwynne
I certainly can. I have had umpteen conversations with Health Ministers from across the United Kingdom, and none of them has indicated to me that they intend to extend this to hospitality. But the point is that, as Ministers in their own legal jurisdictions, it for them to decide who they are going to consult and on what basis they are going to consult. In terms of the powers in this Bill, which areas they want to extend—if any—is a matter for them. It is not a matter for me or for this Parliament.
We are merely legislating to give those Health Ministers the tools; if they wish to go beyond the scope that the English Ministers are setting out, it is their right to do so. That is the devolution settlement. But they will, of course, have the statutory duty to consult, and they will, of course—I would imagine—want to work with businesses, in Northern Ireland, in Wales, or in Scotland, to make sure that whatever measures they bring forward are right and workable, just as we would in the Department of Health and Social Care, should we decide, at some stage in the future, to go further again.
Dr Johnson
I doubt whether the Minister has provided a huge amount of reassurance to the hospitality sectors in those jurisdictions.
I want to pick up on a point made by the hon. Member for Cardiff West in his intervention about prisons. As far as I can tell, closed prisons are smoke-free environments—that is already the case both inside and outside—but I understand that prisoners in closed prisons are allowed to vape, including in their cells, where they may be vaping near other prisoners who may not wish them to have that choice. We are depriving people of their liberty for good reason when sending them to prison, but we should not be exposing them to chemical vapour as part of that if they are not vapers themselves.
Could the Minister talk to us about the discussions he has had with Justice Ministers about how provision is made for the public health of those currently in prison?
Andrew Gwynne
I am grateful to the shadow Minister, who is now making my case perfectly for why we need to have the regulations as we do. It may well be that, at some stage in the future, a Public Health Minister, or indeed the Secretary of State, having had conversations with and guidance from the Ministry of Justice, seeks to quickly and simply extend provisions within the prison estate. Were the hon. Lady’s amendments to pass, the ability to do that would not be in the Bill.
We have had conversations with Ministers across Government. This Bill has been subject to the usual write-around, so it has the collective support of the Ministry of Justice. The details of which areas would be in or out of the scope of different measures within the Bill will be a matter for the regulations and for consultation. With that, the shadow Minister has precisely made the case for why having things prescriptively in the Bill ties the hands of Ministers.
Dr Johnson
The Minister is suggesting that to be able to restrict access to these products in prisons, he needs to have a wide scope within clause 136. Given that prisons are already smoke-free areas, that surely cannot be the case.
Andrew Gwynne
No, but the point the hon. Lady is making is about what conversations Ministers have had with other Ministers to extend the scope, to protect the rights of others and so on. It is precisely for that reason that the Bill is drafted as it is. At some stage in the future, a Government Minister in another Department may well decide that they want to extend the scope, using the powers we are talking about. Under her amendment, we would then have to find a slot in primary legislation to amend a piece of primary legislation. That is precisely why her amendments are unworkable.
The mechanism in place would allow a consultation on an extension; following consultation, secondary legislation would be debated as part of the affirmative process—there would be a debate, a discussion, and a vote in Parliament. That is precisely why the amendments are unworkable, and I call on the Committee to resist them.
I move on to the removal of the test in the Health Act 2006. That is to enable the Secretary of State to more easily make regulations designating outdoor spaces as smoke-free, but only where such a space is a workplace or open to the public. Reinserting the test would conflict with our intention to extend smoke-free status to places I have mentioned—for example, children’s playgrounds probably do not meet the requirement of there being significant risk of significant quantities of smoke. However, making them smoke-free would almost certainly protect some of the most vulnerable.
Since 2006, the evidence base for harms of second-hand smoking has evolved. It is therefore necessary to update the current legislation, as clause 136 does, to provide more flexibility should the Government wish to designate additional smoke-free places in future.
Dr Johnson
The Minister is making a reasonable point. However, the evidence can change on what constitutes a significant amount of smoke—in the past, people may have believed that someone had to be smoking in order to come to harm and then that someone could also come to harm in an enclosed indoor environment with someone smoking. It may be that the evidence now shows that even being in proximity to someone smoking outdoors—the fact that you can smell it means you are breathing it in—means you are coming to harm on some level. But does the amendment not account for that with the word “significant”? Amendment 94 says:
“if in the Secretary of State’s opinion there is a significant risk that, without a designation, persons present there would be exposed to significant quantities of smoke.”
A significant quantity of smoke may in the past have been considered to be quite a high volume, but now might be a much lower volume. The flexibility the Minister is seeking is already provided for in the amendment.
Andrew Gwynne
The shadow Minister would probably have a large degree of sympathy—at least one of her Back Benchers less so—with our updating the Health Act 2006 to allow us to take action to make more places smoke-free. We think that is right. We now have the ambition to make the whole United Kingdom smoke-free, and this is part of that effort.
Dr Johnson
The Minister is being generous with his time. He knows my thoughts on smoking and vaping, particularly in relation to children, and how important I think creating a smoke-free and nicotine-free generation is—although he does not share the second part. He is talking about how the Secretary of State needs to be able to move with the evidence. I completely and utterly agree with that, but the clause says that there is a significant risk that without designation, persons present will be exposed to significant quantities of smoke.
I support the addition of the smoke-free legislation for spaces like playgrounds. If a playground were to be included, the Secretary of State could quite easily justify that by saying that even seeing someone smoking would encourage children to smoke, particularly if it is their parents, and that therefore it is a sensible action to take.
The words—drafted, I believe by the Minister’s predecessors—are “exposure to significant quantities”. “Exposure” does not necessarily mean breathing it in; children could be seeing it across the playground. “Significant quantities” does not necessarily mean a quantity enough to do them harm. If they cannot see it, they are not being exposed to it and it is not doing them harm, why would we want to stop it happening?
Andrew Gwynne
The point is that that is open to interpretation; that now runs counter to our ambition to have a smoke-free United Kingdom. We have put in place a much more flexible and workable measure. The measure from 2006 was right for 2006, but it is not right for 2027, when we hope to introduce the Bill. That is why we are looking to the measures in the Bill rather than the measures as they stood in 2006.
Lastly, I remind the shadow Minister that her amendments apply only to the clause in the Bill that relates to England. If we agreed to them, the powers in England would not be consistent with the powers in the rest of the devolved jurisdictions across the United Kingdom. This is a UK-wide Bill that provides a consistent legislative framework for the whole of the United Kingdom—all four nations—while allowing devolved nations to go further on subsequent regulations if they so wish. For these reasons, I ask hon. Members to withdraw their amendments.
Dr Chambers
I think that the official Opposition’s amendment is better, so I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Amendment proposed: 95, in clause 136, page 77, line 12, at end insert—
“The Secretary of State may only make regulations designating external or open spaces as smoke-free in England outside—
(a) an NHS property or hospital building,
(b) a children’s playground, or
(c) a nursery, school, college or higher education premises.”.—(Dr Johnson.)
This amendment restricts the Secretary of State to only being able to designate open or unenclosed spaces outside a hospital, children’s playground, school or nursery.
Question put, That the amendment be made.
The Chair
I will make a couple of housekeeping points before we move on. First, if there is an amendment, it has to be formally moved. Secondly, could hon. Members not say “you”? Remarks have to be through the Chair. I have let it go for a bit, but most people have been here long enough to know the rules of the House.
Amendment proposed: 94, in clause 136, page 77, line 21, at end insert—
“The Secretary of State may designate a place or description of place under this section only if in the Secretary of State’s opinion there is a significant risk that, without a designation, persons present there would be exposed to significant quantities of smoke.”.— (Dr Johnson.)
This amendment would re-instate existing section 4(3) in the Health Act 2006.
Question put, That the amendment be made.
Jim Dickson
I beg to move amendment 10, in clause 136, page 77, leave out lines 26 to 29 and insert—
“(a) for subsection (1A) substitute—
‘(1A) The Secretary of State must, no later than the end of the period of 6 months beginning with the day on which the Tobacco and Vapes Act 2025 is passed, lay draft regulations to be made under this section which have the effect of providing for all enclosed vehicles to be smoke-free, other than vehicles of the type described in subsection (3).
(1B) Regulations may make provisions about the meaning of “enclosed vehicle”, which may include vehicles which are partially enclosed or enclosed (or capable of being enclosed) for some but not all of the time.’”.
This amendment requires the Secretary of State to make regulations which would extend the existing prohibition on smoking in vehicles to all enclosed vehicles except ships and hovercraft which are regulated under other legislation. The prohibition currently only applies to workplace vehicles and vehicles carrying under 18s.
Amendment 10 requires the Secretary of State to make regulations that would extend the existing prohibition on smoking in vehicles to all enclosed vehicles except ships and hovercraft, which are regulated under other legislation. As hon. Members will know, the prohibition currently applies only to workplace vehicles and vehicles carrying under-18s. The 2015 ban on smoking in cars that contained children was a really important moment in in public health. It raised awareness about the harms of second-hand smoking in enclosed spaces and protected many children from being exposed to those harms.
Gregory Stafford
I agree that the regulations on smoking in private vehicles with under-18s were symbolically the right thing to do. Is there evidence either that the ban was in any way enforceable, or that it had any impact on public health?
Jim Dickson
I thank the hon. Member for those comments; I will do my best to answer them. Compliance with the measure is still not where we would like it to be: the last survey undertaken by an independent company on behalf of Action on Smoking and Health indicates that 9% of 11 to 15-year-olds say that
“they travel in a car with someone smoking some days, most days or every day in 2024.”
The current law also does not protect those with clinical vulnerabilities. The smoke-free powers in this Bill are driven by a desire to protect people with clinical vulnerabilities from second-hand smoke. That includes pregnant women and those with asthma and lung conditions, among others. No smoker wants to harm their family, friends, pets or co-workers, so no smoker should smoke in an enclosed vehicle.
The evidence is clear: concentrations of smoke in vehicles where someone is smoking are greater than in any other small, enclosed space. If we are to be led by the evidence when extending smoke-free places, we have to consider vehicles. That would provide consistency in policy and raise awareness of the harms of second-hand smoke even further than they currently extend. It would be easier to enforce than the current law, where we have to check who else is in the vehicle, and would make the regulations on vehicles simpler and easier to understand—“It’s a straightforward ban; you can’t do it.” Finally, it is worth pointing out that it is supported by the public, with 67% of British adults saying they are in favour of an outright ban on smoking in vehicles.
Dr Johnson
I thank the hon. Gentleman for his clear explanation of what he wishes to achieve. I have great sympathy with it, because nobody wants to see people making their health worse by smoking in a car. However, his statistics are quite interesting. He said that 9% of children find themselves on a regular basis in a car where someone is smoking, yet the Minister has said already this morning that 11% of people smoke. Given that not all of the 11% of people who smoke have children with whom they travel in a car, that implies that the measure is pretty badly enforced and badly adhered to at the moment. He might argue that a complete ban in all vehicles would make it more uniform and easier to enforce, but I am not sure that that is the case.
I will be interested to hear from the Minister when he responds to the amendment whether he has any information or statistics on the number of prosecutions that have occurred under the current legislation. I support the legislation that prevents someone from smoking in a car with children, and I would support an extension of that to include vaping and other nicotine products. I would also support a ban on people smoking while driving; if someone is holding a lit cigarette in their hand, that will have an impact on their ability to manoeuvre the car, particularly in an emergency situation.
Essentially the hon. Member is proposing to say to someone in a parked-up vehicle, perhaps in someone’s drive, “Although you are in a private space, you are not able to smoke.” I understand what he said about no smoker wanting to hurt someone—I am sure that is true—but I cannot imagine that there is any adult smoker that does not realise that smoking in a car with children is bad for the children. I find it very difficult to believe that that would be the case. I invite him to consider whether he is trying to prevent what is a legal activity—even under this Bill, if someone is the right age—in a private space that is theirs and theirs alone?
Gregory Stafford
My comments follow on the shadow Minister’s. My understanding of amendment 10 is that, even if the occupant of the vehicle is entirely alone in their private vehicle, the hon. Member for Dartford is seeking to ban them from smoking in that vehicle. We are in danger here of overreaching on what we need to do to achieve a smoke-free generation.
Jim Dickson
The hon. Gentleman is making his point very articulately. The idea that smoking legislation is an overreach is not new. Just about every change over the last 30 years—changes that have helped to cut very significantly the number of people affected by smoking-related diseases—has been described as an overreach. A lot of this is about public acceptability, and nearly all the polling accepts that a great majority of adults would see this not as an overreach, but as a welcome change.
Gregory Stafford
I do not pretend to have deep wisdom and insight into the whole population’s view on this, and I have not seen the studies the hon. Gentleman talks about, but I accept them. My concern is the need to be careful about the balance between the stated ambitions of all of us—or certainly most of us—on the Committee to reduce smoking as much as possible, and the rights confined within the Bill. If someone is legally allowed to smoke—that is, they were born prior to 1 January 2009—or is over 18 in the case of vaping, and they are in the privacy of their own vehicle without harming anybody else in said vehicle, they can do so. The hon. Gentleman’s amendment is a step too far.
Jack Rankin (Windsor) (Con)
I agree with my hon. Friend that this is a step too far. Does he also agree that this would be an enormous waste of police time? The police often get their priorities wrong as it stands, but the idea that they should spend time prosecuting smoking in a private vehicle is clearly a waste of police time.
Gregory Stafford
I have much sympathy with my hon. Friend’s point of view. I must confess, I am not clear—I am sure the hon. Member for Dartford will be able to tell us—who will enforce this regulation. If it is the police, then I agree with my hon. Friend that it is an unnecessary burden.
Jim Dickson
The police currently have responsibility to enforce a whole range of activities that take place within a car, such as mobile phone use. It would in no way be a new concept for the police to enforce something of this nature. If they saw someone in a car with a cigarette, they would be able to stop the car and apply a penalty as they currently do with other types of behaviour within cars.
Gregory Stafford
I accept that point, but I do not think my hon. Friend the Member for Windsor’s point was that the police do not currently have powers to stop people who are driving dangerously. I completely accept that they should stop people using their mobile phones or doing things that constitute dangerous driving. The shadow Minister gave the view that smoking a cigarette could be counted as driving without due care and attention or dangerous driving, so that may be a way of enforcing it. However, I think that having the police stop someone simply smoking in their own vehicle—something that is legal in every other private location—when they are over the legal age required in the Bill and they are not harming anybody else, is an overreach.
Dr Johnson
The key difference between a mobile phone and a cigarette is that with mobile phones, it is the driver using a mobile phone while driving that is the problem. If one is pulled over in a parking space in one’s private car, one can use one’s mobile phone to one’s heart’s content, and likewise when one is parked in one’s drive. If one wants to sit in one’s car on one’s drive and use a mobile phone, provided the car is stationary, that is also a legal thing to do. What the hon. Member for Dartford is suggesting is not that someone is unable to smoke while driving, which would be quite a sensible measure, but that if one’s car is stationary and private and one is essentially alone in an enclosed space like one’s home, one still would not be allowed to smoke, which seems a little odd.
Gregory Stafford
I completely agree with the shadow Minister. I have two final points. Proposed new subsection (1B) makes reference to the meaning of an enclosed vehicle. I just want to clarify what that means. The amendment says:
“which may include vehicles which are partially enclosed or enclosed (or capable of being enclosed) for some but not all of the time.”
Is the amendment trying to capture convertible cars—someone driving with the top down on a sunny day?
Jim Dickson
The amendment is not intended to change the way that the current legislation relates to individual vehicles, merely the activity happening within them, and that currently permits smoking in open-top vehicles with the hood down, i.e. unenclosed. The amendment does not propose any change to that.
Gregory Stafford
That is a helpful clarification. Finally, in the explanatory statement, it says that enclosed vehicles account for everything “except ships and hovercraft” apparently because that is “regulated under other legislation”. Perhaps it is in a later amendment, but why did the hon. Member decide not to amend the regulations for ships and hovercraft? Is that because he is hoping to get a private Member’s Bill at some point to change whatever legislation governs hovercraft and ships—[Interruption.] My hon. Friend the shadow Minister whispers to me, “It’s further down,” so that clarifies the point for me.
Ordered, That the debate be now adjourned.—(Taiwo Owatemi.)
Terminally Ill Adults (End of Life) Bill (Third sitting)
Tuesday 28th January 2025
(2 days, 18 hours ago)
Public Bill CommitteesRead Full debate Terminally Ill Adults (End of Life) Bill 2024-26 View all Terminally Ill Adults (End of Life) Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 28 January 2025 - (28 Jan 2025)
The Chair
Q
Dr Clarke: I am Dr Rachel Clarke. I am a hospital palliative care doctor with a decade practising in a whole range of settings: the community, hospices, small district general hospitals and a large teaching hospital. I am also a former journalist and a current author who has written four best-selling books for the public about medicine in the UK. I campaign very actively for greater awareness amongst the public around the topic of death and dying. I have extensive experience teaching communication skills to medical students, junior doctors, nurses and other members of multidisciplinary teams. My personal view on assisted dying is that I am not opposed in principle, but I have significant concerns around the issues of consent and capacity.
James Sanderson: Good afternoon. My name is James Sanderson. I am the chief executive of Sue Ryder, a leading palliative and end-of-life care organisation, which also supports people living with grief and bereavement. I have recently joined Sue Ryder and have been there for six months. I was previously in NHS England as director of community health services, personalised care and palliative and end-of-life care. I am also the former chief executive of the Independent Living Fund.
Sue Ryder, as an organisation, has adopted a neutral position in regard to the assisted dying Bill. I am here today to provide information regarding the provision of palliative and end-of-life care and some of our concerns in relation to how the system is currently operating across the country.
Dr Cox: I am Sarah Cox. I am a consultant in palliative medicine. I have been in palliative care for over 30 years. I am also the president of the Association for Palliative Medicine of Great Britain and Ireland. It is a member organisation with over 1,400 members. Naturally, there are different views amongst our membership, but in polls over the last 10 years, the results show that about 80% of our members are opposed to the legalisation of assisted dying and about 5% are in favour. The reason for this opposition are many, but include the inadequate current provision of palliative care, which does not offer patients a choice, concerns about how the safeguards would be enacted in this Bill, and concerns about the impact of assisted dying on palliative care resources, funding and the workforce.
Dr Ahmedzai: Thank you very much for inviting me here today. My name is Sam Ahmedzai. I am a retired professor—a professor emeritus—of palliative medicine from the University of Sheffield. I have—not boasting, Sarah—39 years of experience in the speciality. I was one of the people involved in setting up the new speciality of palliative medicine back in the 1980s. My experience is of working in a hospice for nine years, and then 20 years as a consultant and professor at the University of Sheffield.
I am a clinical academic, so I very much take an evidence-based view of healthcare, and palliative care is just another kind of healthcare. For instance, I chaired the National Institute for Health and Care Excellence guidance on the last days of life. I was also clinical adviser to the NICE guidance NG142 on service delivery in the last year of life. I come from that background. I have experience of lecturing and working around the world as a visiting academic. For 10 years, I was the visiting Spinoza professor at the University of Amsterdam, where I lectured people who were delivering euthanasia in Amsterdam about what they could do through palliative medicine as well. That is where I am coming from. I am a supporter of changing the law, and I commend the Bill. It is the safest I have seen in the world.
The Chair
Members should indicate if they wish to ask a question and who they wish to ask.
Naz Shah (Bradford West) (Lab)
Q
James Sanderson: There are clearly gaps in the provision of palliative care. However, to start with a positive, I think that the provision of palliative care in this country is exceptional. We are leaders in many ways across the world in the way in which we support people who are facing those challenges in their lives. However, our findings in relation to palliative care show that, although about 90% of the population could benefit from palliative care, only 50% of people are currently able to access it.
One of our concerns is that the provision of palliative care across the country is quite patchy at the moment. I do not think there has been a thorough assessment of the level of palliative care in place—not just the provision of palliative care specifically, but how other services, such as district nursing services, interact with palliative care. In some areas, the provision of district nursing services for general care and support for people who may be at the end of their life is very strong and in other areas it is not so strong.
At Sue Ryder, there is one thing that we are really concerned about. In our survey, 77% of respondents said that they were concerned that the lack of availability of palliative care might enable more people to consider an assisted death than otherwise would. That concern went up to 84% for those who were in favour of assisted dying. We really need to look at the provision of palliative care and the specifics in the Bill that make reference to the fact that people should be offered what is available to them. We need to have a much clearer definition of what “available” means.
Naz Shah
Q
“I have studied the reports from, and spoken with medical and nursing clinicians from US and Australian jurisdictions and am satisfied that external coercion has never been reported or led to a prosecution.”
The state of Oregon carried out a survey of people who died under its assisted dying scheme in 2023. Its report stated that 43% of those who chose to die said they did so because they felt they were, and I quote directly from the term used in the survey, a
“Burden on family, friends/caregivers”.
Is that something you are prepared to see happen in the UK?
Dr Ahmedzai: It goes absolutely to the core of being British—we are always saying sorry, aren’t we? We apologise for everything. In everything we do, or everything we might do, we think we might be treading on toes and are always worried about being an imposition. All my professional life, I have come across patients and families in which there clearly is that feeling going on, usually with an older person or even a younger person who is drawing a lot on the emotional and physical resources of the family. It is natural that we feel a burden; it is impossible to take that out of human nature.
The issue is, does feeling that one is, or might become, a burden something that could influence a decision as major as looking for assisted dying? In that respect, I look to all those jurisdictions that have been offering assisted dying in different ways, and I have never seen a single case ever taken to the police or prosecuted. Evidence I have heard from other jurisdictions shows that, yes, it is possible—we all go through life feeling that we are a burden on someone—but it does not influence people in this particular decision. If anything, I am told that, in other jurisdictions, families are saying, “No, don’t do it.” They are exerting negative coercion—“don’t do it” coercion—but people are saying, “No. It’s my life. I’ve made my mind up.” They have mental capacity, and we respect that.
Sean Woodcock (Banbury) (Lab)
Q
Dr Clarke: Based on my clinical experience, I would push back on that in the strongest terms. I am the kind of doctor who believes there is nothing to be gained from sugar coating reality. We have to be absolutely honest with patients and the public about shortcomings, failings and areas where my profession and the rest of the NHS are getting things wrong.
It is my clinical experience that not only are the majority of doctors not necessarily trained in spotting coercion explicitly, but they are often not trained explicitly in having so-called advance care planning conversations with patients around the topic of death and dying, and how a patient would like the end of their life to proceed. It is almost impossible for me to overstate how much avoidable suffering occurs right now in the NHS not because of a lack of resources for palliative care—although that is an enormous problem—but because of a lack of confidence, skill and expertise among the medical profession writ large with these very difficult conversations.
We are all familiar with the idea of death and dying being a taboo in society. People are scared of it, and they hesitate to bring it up with their friends and family. In my experience, many medical students and doctors also suffer from that anxiety. They are scared, and they find it a taboo subject. What that means is that sometimes coercion occurs because the doctor—the consultant responsible for this person’s care—will not even bring up the fact that they think the patient is dying, because it is an uncomfortable conversation. Conversely, I have worked with senior hospital consultants in the NHS who have deliberately prevented our team from accessing their patients, because they believe that the hospital palliative care team wants to kill the patients, and that if I go and see the patient, I will give them a lethal dose of drugs.
These are the kinds of extraordinary misunderstandings and failures to prioritise patient autonomy that are happening now. That is even before we get started on conversations around whether someone would like to consider assisted dying, so it is a huge problem.
Dr Marie Tidball (Penistone and Stocksbridge) (Lab)
Q
Dr Ahmedzai: I have visited many of the jurisdictions around the world—such as Oregon, where I met the original judge who brought in the law, as well as the doctors, nurses and patients involved—and it was clear to me that if patients had not accessed palliative care, they were pointed towards it. Obviously, you cannot force anybody to go and have palliative care, but they were certainly informed about it.
In the Netherlands, I commend a system for doctors called SCEN—support and consultation on euthanasia in the Netherlands. These are trained doctors working for the equivalent of the BMA, I believe, who, as Dr Clarke has referred to, are going and supporting doctors who are not familiar with things. They often come from a background of palliative care and pain medicine, so they are making options available that other doctors in the process, for instance, have not brought up. In Australia, there is clear evidence that palliative care is becoming more available.
The European Association for Palliative Care produced a report more than 10 years ago in which it examined all the countries in Europe at the time, and it found there was evidence that palliative care was improving in scope and availability alongside the forms of assisted dying that were happening there. I am reassured that bringing in some form of assisted dying, particularly the form proposed here, would be a boost to palliative care.
One of the things I would like to see is that anybody who is involved in the process is constantly asking the patient, “What about palliative care? Have you actually accessed it?” Right now, if they have not raised their hand and asked for assisted dying, no one has that conversation with them. They are in a vacuum and a bubble, and not receiving palliative care, whereas this provision would possibly make it more available.
The Chair
Order. I do not want to squash any discussion, but I ask Members and the panel to bear in mind that we have until 3.15 pm for this session. I will be as lenient as I can with questions.
Dr Tidball
Q
Dr Ahmedzai: In the interests of brevity, yes.
Dr Tidball
Q
“entirely consistent with current medical practice and with compassionate care”
to raise assisted dying. You also said that raising the topic did not have adverse effects. How could clause 4 be strengthened to ensure that patients are presented with a range of treatment options at the end of life and relay any concerns that others have raised about suggestibility where this is mentioned in isolation?
Dr Ahmedzai: That is a complicated question. The first point is that right now, as Dr Clarke pointed out, it is scary to patients to be told that they may actually be receiving palliative care. When it has been mentioned—by an oncologist, for example—many patients say, “I do not want that. Don’t let them come anywhere near me or anywhere near my relatives.” It is not unusual that people may have an adverse reaction to just hearing about the service, but here the difference is that the person has actually asked for it.
I personally believe that it would be advantageous if there was formal training, as Dr Clarke has mentioned, specifically to have the kinds of conversations that we now talk about, such as about psychological issues and suicidal tendencies. It used to be thought that if you mentioned suicide to somebody, it would give them the idea, but of course it does not; it saves them, because they say, “Thank you. Yes, I was having those thoughts.” Bringing up assisted dying is never going to be harmful to the person, even if they had not thought of it. They will just say, “Well, it is not for me.”
Rebecca Paul (Reigate) (Con)
Q
Dr Cox: Professor Ahmedzai has talked about the evidence, which was written up to 10 years ago. There is actually more recent evidence, looking at the last 10 years, where European countries and American states have been assessed in terms of the development of palliative care services. That more recent evidence shows that although palliative care services have improved in those countries where assisted dying has been implemented, they have improved three times more in countries where assisted dying has not been implemented. The evidence from that study shows that the implementation of assisted dying is impeding the development of palliative care services.
The other thing we are really concerned about is the impact on funding. It is unclear how this is going to be funded. It looks as if it is going to be within healthcare, and if so, there will inevitably be competition with other aspects of healthcare, including palliative care, for those limited resources. There are finite numbers of doctors, nurses and side rooms in hospitals. If palliative care and assisted dying were funded from the same pot, I think there would be a massive detrimental effect on palliative care because we would be in competition for a limited resource.
I am also concerned about our palliative care workforce, which we know is already in crisis. Eighty-three per cent. of our members told the Royal College of Physicians in 2023 that they had staffing gaps, and more than 50% were unable to take leave because of those staffing gaps. Forty-three per cent. said that if assisted dying were implemented within their organisation, they would have to leave. This has a massive impact on palliative care, in terms of its potential to develop both our funding and our workforce, who are really concerned about this.
Rebecca Paul
Q
Dr Cox: The first thing to say is that palliative care is currently inadequate. Not only do we need to ensure that it does not decline, but we need to massively improve it so that this Bill offers patients a real choice. We know that effective palliative care can change a terminally ill person’s point of view from wanting to die to wanting to live.
We also know that 25% of people who die in this country do not have the palliative care they need. That is more than 100,000 people a year. Providing palliative care, which might make their lives better, reduce their suffering and even change their perspective on whether they would want assisted dying, should be our priority in reducing suffering in this group.
I do not know how we prevent this from happening. Making sure that palliative care has separate funding is important, because assisted dying and palliative care need to be separate in how they are delivered and in how they are funded.
Sarah Green (Chesham and Amersham) (LD)
Q
Dr Clarke: The fundamental principle is always that, by default, the patient has capacity unless there is clear evidence that they do not. We presume that patients have capacity. As doctors, we are obliged to ensure that patients have informed consent when deciding between different treatments. That means we need to lay out the whole array of treatment options, and the risks and benefits of each, to empower individual patients to make decisions for themselves.
Regarding the issue that has been alluded to of whether doctors should be prohibited from raising the issue of assisted dying, it is my belief that that would fundamentally alter the doctor-patient relationship. If consent is not informed—and it is not informed if we are not laying out all the different options to a patient—we are denying patients the opportunity to make decisions for themselves. A patient is always able to refuse every treatment, and in particular every life-prolonging treatment, that they choose to, provided they have capacity. We, as doctors, may think that a decision is unwise, but that is irrelevant, because those days of bad old paternalistic medicine are gone. The patient makes the choice. If a patient says, “I do not want chemotherapy. I do not want to eat. I do not want anything at all—no treatment”, we respect that, unless they lack capacity.
The elephant in the room with all of this is the capacity assessments. I would suggest that anybody who pretends that those assessments are easy and routinely done well in the NHS has not got enough experience of observing that happening. I teach capacity assessments to doctors and medical students, and it is often the case that they are very poorly conducted. The doctor often does not understand the criteria for assessing capacity. That is if it happens at all. Sometimes, a paternalistic doctor will decide that a patient is dying, and we should stop their antibiotics because they are clearly now at the end of their life. They have a chat with the family, who say, “Yes, we agree,” and nobody talks to 82-year-old Mrs. Smith and asks her what she feels about it, because they assume that she does not have capacity because she is old. I see that regularly. Sometimes, a palliative care team will intervene in those situations, because the professional and legal framework that is meant to guide this practice is just not happening. It is a very fraught and tricky area.
If there is one thing that I would say to the Committee regarding making the Bill as robust, strong and safe as possible, it is: please consider seriously the matter of education and training from day one of medical school onwards. Death is at the periphery of a medical school curriculum. Death and dying are not taught. You might get a week of palliative care in five years, and that has knock-on effects all the way through, at every level of seniority in the medical workforce.
Sarah Green
Q
Dr Clarke: Yes, I think that in the spirit of transparency and making this as safe as possible, it needs to be significantly strengthened. I would suggest that there need to be more safeguards in place. For example, if anyone in a hospital—whether staff, patient or family member—has concerns around a particular case, there should be mechanisms for those to be raised in a proactive way. Just as we have guardians of safe working and freedom to speak up guardians in hospitals, those opportunities to assess and appraise the safety in real time once a Bill is in place—I just do not think they are robust enough at all. The more we can have of that, the more that will allay people’s fears.
Daniel Francis (Bexleyheath and Crayford) (Lab)
Q
Dr Ahmedzai: You have caught me on the hop, because I cannot quote the level of training that doctors have received elsewhere, except for examples in the Netherlands, where there are additional doctors who are, through their medical association, trained specifically in assisted dying. I cannot tell you the number of years’ experience that doctors have in other countries. I felt that it was self-evident that you would want doctors who are experienced—three years, five years or whatever post qualification—and who have seen real life. It is up to the medical associations to stipulate how much experience, but I would not like the idea of a doctor immediately, having got their certificate of training, going off and making these kinds of decisions. That is why I suggested that ballpark figure.
Daniel Francis
Q
Dr Ahmedzai: Probably not, but this is a very, very special situation, and it may be, once it has become embedded in the health service, that that stipulation could move back.
I am so glad that Dr Clarke keeps coming back to training. One thing that is absolutely needed if this Bill goes forward is to take the topic of assisted dying out of being an optional training—where people might sign up for a course—to become mandatory. In the NHS, we do mandatory training for all sorts of things, including washing hands, lifting and basic life support. There should be basic dying support mandatory training as well. Why do we not have that? That kind of provision would become part of training doctors up to become good at those conversations that Dr Clarke is obviously involved in teaching, and in ensuring that they keep up to date with how the law is changing too. I would look to the royal colleges and the GMC to lead on those aspects.
Dr Simon Opher (Stroud) (Lab)
Q
Dr Clarke: I absolutely agree that in a small number of cases, palliative care at the highest level cannot eradicate all suffering, and cannot prevent a person from wishing to end their life and have assistance in ending their life. That is absolutely the case; I would say that it happens surprisingly uncommonly, in my experience, but it does happen.
Autonomy is the crux of the issue for me, because autonomy is predicated on having meaningful choices. Can you actually choose option a or option b? Let us say that option a is high-quality not just palliative care, but medical care in general—district nursing care or social care, for example. If that is not available to you, you are potentially being pushed towards “choosing” option b—the route of assisted dying—not freely and not autonomously, but because option a has been denied to you by real-world failures. We all know about those real-world conditions—we are all familiar with the latest winter crisis, where patients have been dying on trolleys in corridors, etc—that are preventing the actual option of a death in which dignity, comfort and even moments of joy can be maintained right up until the end of life, when that patient is getting the high-quality palliative NHS and social care that they need.
That is the crux of the issue. If you do not have that as a real option for patients, we can say that they are choosing autonomously assisted dying, but actually society is coercing them into that so-called choice because it is not funding the care that makes them feel as though life is worth living. That is why I think many of my colleagues are so concerned about legal change now. It is not because of an opposition to assisted dying in principle. It is because the real-world conditions of the NHS today are such that people’s suffering means that occasionally they will beg me to end their life, and I know that that begging comes not from the cancer, for example, per se, but because they have been at home not getting any adequate pain relief. Once you start to provide proper palliative care, very often that changes.
Danny Kruger (East Wiltshire) (Con)
Q
Dr Cox: I and my colleagues have concerns about the safeguards in the Bill. It is not just the capacity assessment; we also acknowledge that prognosis is incredibly difficult to assess accurately. I would say that you cannot always identify coercion. You can identify it when it is very obvious and extreme, but when it is very subtle, we cannot always identify it. After the event, there is nobody to tell us about coercion, so it is very difficult to monitor.
The other thing that concerns me is that we are putting all these assessments on the shoulders of two doctors individually, followed up by a High Court judge. In any other clinical practice, when we are making very serious decisions, we know that shared decisions are much better quality, much more robust and much safer. In clinical practice, we make all these decisions in multi-professional teams. I would never make these decisions independently of my team, because the perspective they bring can help me to understand things that I am not seeing.
The thing that I am really concerned about is how it is possible for these doctors, even with training, to have a good understanding of all illnesses in order that they can identify prognosis—neurological, cancer and every other. How is it possible for them to really understand capacity when capacity is not an absolute; it does change and it is very complex to assess? How is it possible for them to see all cases of coercion, which can be invisible?
In addition to that, are those doctors going to be looking out for opportunities to refer to palliative care when they see somebody who has suffering that could be addressed and may change their mind? Are they looking out for untreated depression? We know that treatment of depression can result in people changing their minds about wanting to die. It is a lot to ask these individual doctors to do, and that really concerns me.
Kit Malthouse (North West Hampshire) (Con)
Q
Dr Cox: There are two differences that I would identify. The examples you give are of somebody who may be naturally dying and is being kept alive, so the difference is that you are withdrawing a treatment; you are not intentionally killing them. This is the first difference with assisted dying.
The second difference, I would say, is that you are absolutely right that we do make those decisions with patients—with their families, if they wish—but in a multi-professional team. I would almost never make those decisions as an individual doctor without the support of my colleagues, for several reasons. First, as I have said already, that makes for much better decisions—they are safer and more robust. Secondly, the moral distress associated with these decisions is much less if you share them. That is also a worry for me—what happens to the moral distress of the co-ordinating doctor and the other assessing doctor? They are carrying a lot of moral distress. My understanding is that a very small percentage of doctors will want to engage with this—maybe 1% or 2% of all doctors will want to be in those assessing positions. They are carrying a lot of that distress because they will be doing a lot of assessing.
Kit Malthouse
Q
Dr Clarke: I think that is not quite right, and certainly not what I intended to convey. There are rules. There are very clear legal and professional rules and guidance and protocols around how to have these conversations. However, in practice, the quality of the conversations is contingent on the confidence, expertise, training and background of the individual clinicians having the conversations. There can be a great deal of inter-doctor variability in how conversations are conducted. In terms of addressing that, I would suggest that in an assisted dying scenario the crucial thing is to make the guidance and training as robust as it possibly can be to reduce the inter-practitioner variability.
Kit Malthouse
Q
Dr Clarke: No, of course not.
The Chair
Order. We have half an hour left. Nine people have asked questions and there are eight people left who want to. If we want to get through the questions by 3.15 pm, people will have to be self-disciplined when they ask their questions.
To the panel, forgive me, but we need answers in as reasonable a time as possible given the circumstances. Dr Clarke, if you wish to answer the last point, feel free.
Dr Clarke: Of course we want as much autonomy for as many patients as possible. The issue is around safeguards. If, for instance, you say to a vulnerable patient who has just been told they have a diagnosis of terminal cancer, “Have you thought about assisted dying?”, I would suggest that stating it broadly like that is a form of pressure and that you are potentially unintentionally coercing that patient. The very act of raising assisted dying in that way will make that vulnerable patient think, “God, is this doctor telling me that my life is not worth living any more?” Autonomy is much more subtle and complicated than we assume from outside.
Juliet Campbell (Broxtowe) (Lab)
Q
“Sadly, only half the people who need palliative care receive it.”
In your opinion, who are the people who receive palliative, and who does do not?
My question to Dr Clarke is similar. You have talked about the population being
“carved up into two groups…those who deserve to live and those are expendable”.
Could you expand on that quote and the two groups you referred to, as well as the impact that has on their treatment and care?
James Sanderson: You draw a really important point about not just the provision and totality of palliative care across the country but the inequity of access. Unfortunately, we find that the diversity of people who are accessing care in hospices across the country is less than those who are dying in hospital—43% of people currently die in hospital.
One of the things we really need to do is move to a new ecosystem of palliative care that looks at supporting people in different settings. We need specialist provision in hospices to support people with significant needs, but increasingly hospices are reaching out beyond their walls into the community, and 80% of Sue Ryder’s work is in people’s own homes. People tell us that they want to die at home, so supporting people in their own homes enables us to access more diverse communities and get to people in their own setting.
Increasingly, one of the things we feel is necessary is the provision of support inside hospital. Alongside wards, we would bring support to that 43% of people who are currently dying in hospital, to ensure there is equality of access in all places, both in in-patient settings and in the community. You draw a really important point that we have to look at the totality of provision and ensure that, when someone is offered palliative care—the Bill talks about that provision being available—there is universal access, in terms of the type of palliative care available and the access for everybody in society.
Dr Clarke: My comment refers to the fact that there is an immense gulf between the theory of the NHS being a cradle-to-grave service—or a service that cares for us at the end of life as it does at the start—and the reality. The reality that I see every day at work in my hospital is patients coming into the emergency department from the community sometimes in utter, abject misery, in agony, with a lack of dignity. They have been forgotten completely. They are not getting healthcare or social care, and no one cares about them.
Even in the hospital, patients who have a terminal diagnosis are sometimes cast out into the corners of the hospital. There are hospitals, and mine is one currently, where we do not even have a 24/7 palliative care service face to face. Every night in my hospital, and every weekend from Friday to Monday, you cannot see a palliative care nurse or doctor, despite the fact that for a number of years that has been an NHS standard. That is an absolute disgrace and it shows how little people who are dying are truly cared for in a civilised society.
It does not necessarily have anything to do with assisted dying, except that if we do not address that simultaneously, some of those people will “choose” to end their life, because we as a society do not care about them enough to give them the care that might make life worth living. Surely that is a travesty for Britain.
Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)
Q
Dr Cox: My understanding of the plan is that in the Bill—forgive me, but I am sketchy on this—the aim is for the registration to be as a natural death. It would not be referred to the coroner, and “assisted dying” would appear on the death certificate.
I am also a medical examiner. My concern is that, as a medical examiner, I am obliged by law to scrutinise all deaths to ensure that a referral to the coroner is not required and to identify any learnings. What concerns me in that role is whether enough recording is happening around decision making and the process to do my job properly. With my medical examiner hat on, do I know what happened? I do not see anything written down in the Bill about the records that are to be kept. What happened when the patient took the substance? What happened afterwards? Were any actions taken in the meantime? That is not so much something I have thought about a lot with my palliative care consultant hat on, but as a medical examiner it concerns me.
Dr Clarke: For the sake of time, I do not have anything to add. I completely agree with that.
Jack Abbott (Ipswich) (Lab/Co-op)
Q
Dr Cox: In European countries and American states.
Jack Abbott
Q
Dr Cox: I suppose it depends who you are. If you live in one of the postcodes where you cannot get palliative care, if you are socially deprived, if you are a member of an ethnic minority or if you have a lung cancer diagnosis, you will not get very good palliative care in this country. I think that is awful.
Jack Abbott
Q
Dr Cox: The position we would ask you to consider is whether this is the right time to bring in a law to give people a choice of assisted dying, when they do not have the choice to have good palliative care.
Jack Abbott
Q
Dr Cox: The NHS is very different from any other jurisdiction—
Jack Abbott
Yes, so the direct comparison is not necessarily relevant. Is that correct?
The Chair
I understand that, but address it through the Chair.
Dr Cox: Palliative care may well have improved in this country over those years when it also improved in other countries where assisted dying was not available. What we are saying is that there has been chronic underfunding of palliative care, so where we are now is inadequate.
Tom Gordon (Harrogate and Knaresborough) (LD)
Q
Dr Cox: I accept that there will be people even with a very good palliative care system who would still choose assisted dying. We do not currently have the very good palliative care system that we need. That is the thing that concerns me.
Tom Gordon
Q
Dr Cox: I will give you some examples. We need to make sure that the 75% to 90% of people who are dying and need palliative care are getting it. We need to make sure that there is not inequity in palliative care, so that you do not have to be white and rich and have cancer to get good palliative care. We need to make sure that hospitals have seven-day services. Seven-day-a-week cover is unavailable at 40% of hospitals. We need to make sure that communities have telephone advice services at night. One in three do not have any advice overnight for patients and their families to access. There are some concrete things that we could change to demonstrate that we are delivering a good service. But currently we are not.
Tom Gordon
Q
Dr Cox: I would love to see it continue. I am part of the commission on palliative and end of life care. There is no guarantee that the recommendations of that commission will be funded, and that is what concerns me. I would love to see that happen. Would it not be great if the two could happen simultaneously? But there is no guarantee that that will happen.
James Sanderson: I want to come in on your point and agree with Sarah’s points. Obviously, we welcomed the Government’s announcement of the additional funding for the hospice sector, but the Committee will be aware that the hospice sector currently receives only about 30% of its funding from statutory sources. We are therefore reliant on the good will of the population to raise money and support us in various ways, and through retail and other ventures that we have.
On the point about universality of service, we have in the Health and Care Act 2022 a requirement for integrated care boards to commission palliative care services that meet the needs of their population, but although there is guidance as to what that should look like, there is not universal take-up of that guidance and delivery of all of the stated services. Although that is outside the scope of this Bill, it comes back to the context of how much the overall position can be strengthened across the country. The context for anybody looking to make a decision is within the same space. As Dr Clarke said in respect of informed choice, if the context is the same for everybody, we can have more confidence that that informed choice is made at the right level.
Kim Leadbeater (Spen Valley) (Lab)
Q
To go back to your point, Mr Sanderson, it is important to acknowledge the fantastic work that palliative care professionals do. Indeed, it is extremely important that we are having these conversations, which is why we gave extra time to this panel of witnesses.
Dr Cox, on your point about the pressure on the individual doctors involved in the process, the Bill is very clear that if they do not have the relevant specialism, they must refer to a specialist in that condition, and they “can” refer to a psychiatrist. There is probably consensus that we maybe need to strengthen the Bill in that regard. When there are doubts around capacity, doctors probably “must” refer to a psychiatrist. That is something I am taking away from these sessions.
I was interested in the comments about the multidisciplinary approach. We heard about that this morning from colleagues in social work and in nursing. I would love to know your thoughts, Dr Ahmedzai, about the idea of a multidisciplinary approach. I think there is a lot of value in that.
Dr Clarke, on this concept around training, it worries me that we have seen this afternoon a very different picture painted by you and others compared with what we heard this morning, when we had doctors and nurses telling us that they regularly assess for capacity and coercion. They said it is part of their day-to-day work and they were very confident in their ability to do that. Training is fundamental, and this is an opportunity to look at gold-standard training. I would be interested to know your thoughts on that.
Dr Ahmedzai: You asked me about the multidisciplinary nature of this. I am really glad you raised that, because we seem to be focusing on palliative care as being very professional, and I would remind people that there are levels of palliative care. A lot of palliative care is given not by specialists like the three of us here but by generalists—either GPs, as we have heard, or by oncologists or geriatricians. When we talk about increasing palliative care and improving palliative care, it is not just about more doctors like us working at a specialist level.
The other thing is that it is not just doctors. We have to acknowledge that nurses are on the frontline; they do so much more than doctors. When doctors clock off at 5 o’clock in those sad institutions that still do not provide 24/7 cover, there are nurses at the bedside all around the clock. Then, there are social workers, physiotherapists and others. If we are talking about meeting the needs of people who may not necessarily have pain but have other forms of suffering or worries, which are not even physical—the loss of dignity and the loss of independence—nurses are so good at supporting people in that. A doctor will just get in the way.
What we need to do is make sure that we are addressing the reasons why many people choose this. I know, from speaking to people abroad, that it is loss of dignity and loss of independence. Is that not a legitimate reason for wishing that you were not a burden on somebody, or on the state even? It is really important that we consider that.
The other thing to bring in as well, if we are thinking about the big picture, is another elephant in the room: palliative care is not strictly speaking actually in the NHS—not all of it. A lot of it is outside of the NHS, for historical reasons from 50 or 60 years ago when decisions were made. Although there are excellent charities providing discrete areas of it, we rely so much on non-NHS services. You would never think of going to a charity to get your heart transplant or your kidney dialysis. We need to confront the fact that palliative care is fractured because of that history and the genesis of how palliative care came to be. It is not just NHS. We must think about the multidisciplinarity.
Dr Clarke: Regarding training and how much it is required, I would not be the first person to make the observation that sometimes doctors can be very pleased with their own abilities at a particular practice, and that practice might be having a conversation where you are assessing someone’s capacity.
What is interesting as a palliative care specialist is that I and my team will be asked to get involved with patients in every possible bit of the hospital—surgical wards, medical wards, intensive care, emergency departments—so you actually see a huge number of patients being treated by many different teams and many different doctors, junior and senior, all of whom are having these difficult, nuanced conversations around the end of life with varying degrees of skill. Of course some doctors and nurses are superbly skilled at having them, and I would say that there are many who are not.
The reason training is so important is that it is a little bit like Donald Rumsfeld’s unknown unknowns. You might not even be aware of the fact that you have caused a patient or their family distress. In a conversation where fear is a dominant part—the patient is fearful of suffering misery and loss of dignity at the end of life, but they may not voice that—you as the doctor can be completely oblivious of the fact that you have sort of stamped over those unvoiced fears with your hobnail boots. You are not aware of it.
This idea that a vulnerable patient needs to be absolutely at the centre of any conversation you are having is quite radical in some parts of the NHS. It needs to be taught much more assertively from day one of medical school, so that vulnerable patients are always at the centre of the room. That is why I think the single most important thing for the Bill and its safety comes down to training and actually recognising that these conversations are difficult and nuanced. If we assume that, we are going to make sure that the Bill is as safe as it can be.
Lewis Atkinson (Sunderland Central) (Lab)
Q
James Sanderson: I welcome the provision in the report. What is necessary is a benchmarking of the current position. Rather than waiting a significant period of time to do a review, we need to benchmark the current state of palliative care and then base subsequent reviews on any changes. As I mentioned before, we also need to look at the wider context. If we look narrowly at the provision of palliative care, we will not properly see what goes on across the whole environment of the health service and social care.
We have mentioned the fact that district nurses and general practitioners are providing a huge amount of palliative end-of-life care, so it may not just be what goes on inside hospices and in palliative care teams in hospitals. I agree that that needs to look at the demographic information so that we are collecting details on who is accessing palliative care and where, and the certain types. All that is necessary as part of the review.
Dr Cox: I agree completely that we need to be doing reviews now and in the future regularly on palliative care aspects. I also think there is an opportunity to write into the Bill other monitoring that would be really helpful in ensuring safety on an ongoing basis. That includes monitoring in terms of decision making—how often assessing doctors refer to others, how often they disagree and what happens after the declaration.
In the Bill there is, as far as I could see, no limit to the delay between the declaration and the request for the substance. That would be an interesting thing to look at in the future, because somebody could delay for six or eight months. Do we do another capacity assessment then? That is a tricky question. What about the taking of a substance? We have not talked about that. There are a lot of things we could look at in future that would be really helpful to monitor.
Lewis Atkinson
Q
Dr Cox: It is really difficult to know how many people who die by suicide because of their terminal illness would instead access assisted dying, and it is really difficult to understand the impact of assisted dying legislation on that. If we look at the evidence of suicide, we know that it is increased in people with serious illnesses, but it is actually increased in the first six months after diagnosis, not in the last six months of their lives, so it is about the trauma of the diagnosis. What we need for that is better mental health services, better support around diagnosis and earlier palliative care.
The other piece of evidence that I would offer to you is that the global picture of what happens to suicide rates after assisted dying legislation is introduced is confusing and mixed. But there are jurisdictions, for instance Germany, where after the introduction of assisted dying legislation the incidence of suicide has gone up year on year. I do not think we can say that introducing assisted dying legislation will stop those suicides.
Rachel Hopkins (Luton South and South Bedfordshire) (Lab)
Q
I was struck by the way the RCN talked—and you, Dr Clarke, used the word as well—about not being paternalistic, about having the patient at the centre of that conversation, and about ensuring that we listen to the patient and ask them, “What is it that you want?” That, for me, is all about autonomy. Do you agree? The emphasis must be on patient autonomy and their choice at the end of life.
Dr Clarke: One hundred per cent. Sometimes, those of us who work in palliative care almost see the extent to which we try to place the patient at the centre of everything as quite radical, when contrasted with a lot of the other medical specialities. My opinion about what is best for a patient does not matter; their opinion is what counts.
The power of the multidisciplinary team, and the reason for thinking that it may be worth considering amending the Bill so that there is a greater role for a multidisciplinary team, is this: the fact that everybody in that team brings their unique perspective. In my hospital, whenever there is a tricky issue regarding a palliative patient, we will have an MDT. There may be 10 people in the room, all discussing the issues. It might be that someone has decided that they want to withdraw their life-prolonging treatments, or they want to have life-prolonging treatment and, for whatever reason, it is really complicated. We will have the patient, their family, doctors, nurses, social workers and dieticians—a big group of people—in the room because that is the way to make the decision most safely and most effectively, in terms of enabling the patient to have the treatment that they wish to have. It is incredibly important to have that.
Rachel Hopkins
Can I ask Mr Sanderson to reflect on that, for the different context, Mr Dowd?
The Chair
No. Order. We have two and a half minutes to go. One other hon. Member wants to ask a question. I want them to come in.
Sarah Olney (Richmond Park) (LD)
Q
Dr Cox: I think it is a choice for the patient. It is always a choice for the patient who they want to involve from their social circle, whether that is family or friends. However, I think that if the patient wants the family involved, then they absolutely should be, and they should be part of those conversations and discussions.
Kim Leadbeater
Q
Dr Ahmedzai: Clearly, British people have had that option for many years, since Switzerland first offered that. It is clear that two things happen. One is that it selects people who are better off and more functionally capable—they can do it—so it discriminates against disabled people. Also, people tend to do it long before they need to, when they are still fit. That is because mostly, they want to go on their own, without dragging relatives along. It is doubly damaging to families who are going through an illness with somebody who is dying. They have to say goodbye to them long before they need to. However, that is because we do not offer that option here.
Kim Leadbeater
Does anybody else want to comment? Dr Cox?
Dr Cox: I am happy to. Of course we do not want people to have to make that choice. I will refer to everything I have said before: are they are making a real choice, and have they had access to really excellent palliative care?
I also make a brief point about the impact of the discussion around what dying looks like that the Bill has raised, and the fact that the stories that have been told have suggested to many members of the public that death is inevitably ugly, horrific and dramatic. Actually, that has made many people fearful, and they have been emailing me and saying, “I am now afraid of dying, and I wasn’t before.” They may then choose assisted dying before they need to because they have had a fear instilled in them that death is inevitably horrible and dramatic.
The Chair
Order. That brings us to the end of the time allotted to the Committee to ask questions. I thank our witnesses on behalf of the Committee for their evidence.
Examination of Witnesses
Sir Max Hill KC, Alex Ruck Keene KC and Sir Nicholas Mostyn gave evidence.
The Chair
Q
Sir Max Hill: Good afternoon. I am not sure how much by way of introduction you want, so please stop me. I was the UK independent reviewer of terrorism legislation 2017-18, and the director of public prosecutions 2018 to 2023—so I stopped 15 months ago. I am not a campaigner; I am here to bring any experience of criminal casework that I may have picked up along the way, as that was part of my diet as DPP. I have been quite close to the construction of the Bill, and I am happy to deal with any questions that I can.
Sir Nicholas Mostyn: I am Nicholas Mostyn, and I was a judge of the High Court family division, of the Court of Protection and of the administrative court until 2023, when I retired with the onset of Parkinson’s disease—which is a genuine slippery slope, unfortunately. I am now a podcaster and devoting myself to alleviating the hardships of people living with Parkinson’s.
Alex Ruck Keene: I am Alex Ruck Keene. I am a barrister in independent practice, and I need to emphasise that I am giving my evidence as a self-employed barrister, not on behalf of any organisation I am associated with. You will have seen from my written evidence that I am associated with quite a few different organisations, because my practice and career straddles both advising and appearing in court cases involving mental capacity. I teach law on the end of life as a professor of practice at King’s College London. I am also heavily involved in law reform in different ways; for instance, I was the legal adviser to the Independent Review of the Mental Health Act 1983. I also do an awful lot of training in the context of mental capacity of both healthcare and social care professionals.
Naz Shah
Q
Sir Max Hill: If the problem is anybody in future going on their own or accompanied by their loved ones to Dignitas, the answer is no—this Bill does not satisfy that. What we have learned from other jurisdictions around the world, where we see broader or multiple groups beyond the terminally ill who are entitled to use new legislation, has not been the model for this legislation, unless you and Parliament were to dramatically change it. The nuanced answer to your question is that this Bill does provide an opportunity for those in the category of being terminally ill, as defined in the Bill, to no longer have to resort, on their own or supported by loved ones, to going to Dignitas. So, yes, it can and will make a positive difference.
I should add, in answering this question, that my often-quoted personal experience is that 27 cases investigated as assisted suicide came across my own desk as the DPP —five to six cases a year. A substantial proportion of those cases did involve Dignitas, because an accompanying relative who had returned alone was then investigated, but a proportion did not involve Dignitas at all, because there had been deaths at home. Of all those 27 cases, I made the decision to prosecute in only one, which was the case of an individual who was 19 years of age encouraging another teenager to end their life. That was a correct and successful prosecution.
I will also add—because until 15 months ago I was a prosecutor, and prosecutors look to bring criminal cases whenever the law is broken—that there was an additional handful of cases in which, although I was not making the personal decision, I supported authorisation of charges for murder or manslaughter where it was clear that an individual’s life had been brought to an end not at the time of their choosing. It is perhaps important to remember that this Bill, as and when passed—that is a matter for Parliament—would not truncate the homicide jurisdiction in this country. It will still be possible to prosecute for murder in those cases when one would expect to be prosecuted for murder. I think it is important to say that, as a very recent former prosecutor.
Naz Shah
Q
Sir Max Hill: That small handful of cases involved an elderly couple where either he—it was usually a he—or she had chosen to bring to an end the life of their lifelong partner and, once that act had been carried out, claimed that it was an assisted suicide in circumstances where the surviving partner was merely carrying out the wish of the person now dead. There are a handful of cases in which that is clearly wrong and should not be accepted and where murder should be the offence brought before the court.
The point, though, is that throughout the time that I served as DPP—and, indeed, the time served by all my predecessors—we did not have the coercion offences created by the Bill, which I suggest would be a significant advance, and nor did we have a legal system in which the investigation was taking place before the death. It was the other way around. In each of the 27 cases I considered, the deceased individual was already dead, and that is when the scrutiny started. The major advantage of the Bill, if I can put it that way, is that that will be reversed, and scrutiny will be before death. In the case of coercion, where it fits the new potential clauses, prosecutions can—and, I am sure, will—be brought.
Dr Tidball
Q
Sir Max Hill: I think that coercion and the coercion clauses in the Bill should be read alongside the capacity clauses. What we are looking for, as required by clause 1(1) and clause 1(2), is a clear, settled and informed wish, voluntarily made without coercion or pressure. Those aspects were taken, at least in part, from the Crown Prosecution Service guidance on 1961 Act cases. Capacity involves understanding information, retaining it, using it and communicating it. If those hallmarks are not there, you may be in a situation where you should be considering coercion. I think you read the two together.
To answer your question directly, the criminal liability clauses—clause 24, and the new offences in clauses 26 and 27—are robust. As a matter for your scrutiny, they are aspects that we do not have in the law at present. There is, of course, the addition of clause 36, under which you cannot be a witness or a proxy to the procedure that is enshrined in the Bill if you are too close to the terminally ill person. That is another hallmark of the Bill that will hedge against coercion.
Dr Tidball
Q
Sir Max Hill: My inclination is that clause 26, which is part of the full body of the Bill, is the right place for this. As with the interpretation clause, clause 40, and as with the way we interpret statute as a matter of course, there are aspects of other statutory offences or Acts of Parliament that help us when we are seeking to determine what coercion is. The creation of the offence of coercion and control, now very commonly used in domestic abuse investigations and prosecutions, has brought us into this territory. It is not beyond the wit of anybody who seeks to use and interpret this Bill to also look for other parts of statute that deal with coercion.
I make the same point about capacity. What is in the Bill is very slender, one might say, because clause 3 simply invites the reader to look across to the Mental Capacity Act 2005. But that Act is very clear on what mental capacity is and how it is defined. I think what I am saying is that it is a drafting point, and I am not a parliamentary draftsman, but I do not have a problem with the definitions of dishonesty, coercion and pressure being in clause 26, where they are. It is not the only place one would look, though; there are other sources.
Dr Tidball
Q
Sir Max Hill: “Dishonesty” is a term of art in common use, but it is also a term of statute. Anyone investigating or, still more, prosecuting would understand what dishonesty means. I accept that there is a wider point—not so much for interpretation but for understanding—that this Committee may want to consider, of how much of that existing definition needs to be imported into the Bill. As with mental capacity, I would suggest that, beyond perhaps the odd footnote, it is not necessary for you as a Committee to define again what dishonesty means, because we have it elsewhere.
Alex Ruck Keene: On pressure, I think the Committee would be really assisted by having a look at the learning of the High Court judges exercising their jurisdiction under the inherent jurisdiction in relation to people who are said to be vulnerable. They have developed an awful lot of tools, where they are trying to look at people in complicated situations—potentially, but not necessarily, with impairments—who are caught up in what one person brilliantly described as being caught in a spider’s web. Those are the sorts of sets of tools used when judges are trying to work out what is going on, and whether it is the side of the line we consider to be acceptable or the side of the line we consider unacceptable—because “pressure” is doing a lot of work there.
Jake Richards (Rother Valley) (Lab)
Q
Sir Nicholas Mostyn: One per cent would be 6,000 deaths a year. If each took two hours to process in the High Court—you have to read it and hear the evidence; one of them has to be oral and you have to write a judgment—that is 12,000 hours. Each High Court judge does 1,000 hours in court—outside court, they do lots—so you are talking about nearly three quarters of the entire family division doing nothing but this. It is impossible, in my opinion, for this to be done by the High Court. It should be done in the Spanish way by a panel that is set up. In Spain, the chairperson of the regulator sets up a panel for each case—a doctor and a lawyer. They have to agree and they check that everything has been done lawfully. They do not make any value judgment about whether it is in the person’s best interest. They check that it has all been lawfully.
Interestingly, in 2023, 10% extra denials were done by the panel. I do not know whether that was because they were concerned about voluntariness or whether they were concerned about suffering—because the criterion is suffering there—but an extra 10% was done by the panel, so the panel was not just rubber-stamping. They denied an extra 10%. I believe that an ad hoc system like that, with a doctor and a lawyer doing a check, would be the best way of doing it. The High Court—trust me, I’ve just come from there—has not got the capacity to deal with 6,000 cases of this nature.
Jake Richards
Q
Sir Nicholas Mostyn: Can I just answer before he does?
Jake Richards
Yes—it’s just that otherwise I will be cut off. I was trying to get two questions in.
The Chair
Order. I said earlier that this is not a dialogue. Address your comments to the Chair, and I will decide who speaks and when. I do not wish to be rude, but everybody’s got to have their fair share.
Sir Nicholas Mostyn: I do not know if you have seen Sir Stephen Sedley’s memo, which came today. He has suggested that the Official Solicitor should be the checker of these facts, which seems a sensible idea. The Official Solicitor would be able to recruit more staff to do this. It would not be nearly as expensive as High Court judges, and it would be an efficient way of dealing with the problem. The advantage of the Spanish system is that you have a qualified doctor as well as a lawyer doing the checking. Remember—a High Court judge is not going to be a qualified doctor. That is a significant advantage in my opinion.
Danny Kruger
Q
Sir Max Hill: I am not sure about that. I would always default to the code for Crown prosecutors and the two tests that the prosecution must go through, regardless of the crime that is being investigated. The evidential stage test sets out what it is necessary to be able to prove—some people say to a reasonable level—to afford a reasonable prospect of conviction. One can well imagine that, in Dignitas cases, that hurdle or test is often satisfied. It was often satisfied in the cases that I considered, and could often be satisfied in the future, but the evidential stage test being satisfied does not always mean that a prosecution results. That is because prosecutors must then go to the public interest stage and consider the non-exhaustive list of factors that are set out in the public interest stage test together with other policy, which, in this area of law, has developed since the legal case of Purdy in 2009.
In common with many other forms of crime, there are some legal policy considerations that a prosecutor is entitled to consider. They start at the very obvious—for example, what is the age of the suspect? Here, one is not thinking about the deceased who has gone to Dignitas. What is the age of the suspect? What are their characteristics? Have they ever committed a criminal offence before? What is their proximity to the case? What motivation did they have, emotional or otherwise, to lend assistance that technically means they have committed the offence?
I am going through that because, as I said, a proportion of the cases I considered were Dignitas cases, and it was often at the public interest stage that I determined that a public prosecution was not necessary. That is because, after full investigation, it transpired that the surviving relative had acted wholly out of compassion and, may I say, love for the deceased and was not seeking any gain for themselves—far from there being any dishonesty before or after the fact. That would still remain the case. It does not follow that, were this Bill to pass and were people then to take elderly relatives to Dignitas, they would necessarily face prosecution, but the premise of your question is “Could they?” and the answer to that is yes.
Danny Kruger
Q
Sir Nicholas Mostyn: I do not agree.
Danny Kruger
Q
Sir Nicholas Mostyn: I think it is unlikely. I am sorry for interrupting you. I always used to say, “Don’t interrupt”, so I am sorry about that.
I fear that I will be one of the people, referred to by the lady who asked the first question, who has to go to Dignitas—frankly, I could afford to do that—because the Bill is not ever going to provide an assisted death for me. I will not be graphic about what the advanced stages of Parkinson’s are like, but the medical Members among you will be able to describe what is likely—not definitely; I do not want to say definitely—to await me. I am choosing my words carefully. It is either going to be a poor death here or to go somewhere like Dignitas. If my children took me as far as Calais, and then helped me after Calais—assistance only applies to within the jurisdiction—and drove me on to Zurich, I would be extremely surprised if any prosecution ensued.
Danny Kruger
Q
Alex Ruck Keene: I think there are two different questions. First, is any idea of capacity sufficient at all? I think that is an existential question that I am just going to park. Turning to the Mental Capacity Act itself, it is important to understand that there are three different bits of that Act in play. We have a set of principles: the presumption of capacity; the presumption that you have to provide all practicable support before you find someone to lack capacity; and the idea that you cannot, just because a decision seems unwise, say that someone lacks capacity. Then we have a functional aspect—in other words, can you understand, can you retain, can you use and weigh the relevant information, and can you communicate that decision? We also have what some people call the diagnostic element—in other words, is there an impairment or disturbance in the functioning of the mind or brain?
These are the three separate things, all of which we make work—more or less—in everyday practice. I say “more or less”, because yesterday I was on the advisory group for a project funded by the National Institute for Health and Care Research, which was funded in 2022 to try and increase the quality of mental capacity assessments in healthcare settings. We need to be under no illusions about how well we are doing it at the moment, but we make it work, more or less.
The Mental Capacity Act works more or less in the healthcare context, because every time we reach the view that someone cannot make a decision, we have an alternative—we can think about best interests. What we are asking the idea of mental capacity to do here is different, because there is no suggestion that, if you cannot support someone to make a decision, you will ever make a best interest decision in their name to assist death. It is also not obvious that the idea of a presumption of capacity should apply. If I doubt that you have capacity to make the decision to take your own life, or end your life, but I cannot prove it, is it logical or are we required to proceed on the basis that you do? Also, it is not immediately obvious that it is right that the diagnostic test applies in this context. In other words, I think you cannot understand the information, but I cannot prove the reason that you cannot understand it is that you have an impairment or disturbance. That is where my concern came in when I was explaining it in my written evidence.
I want to be absolutely and totally crystal clear: as far as I am concerned, at this stage, this is policy development. I am so glad that evidence is being taken and the public is thinking about this, but a Bill of this nature needs to be drafted by the Office of the Parliamentary Counsel. I am really trying to get across the policy line, which to me is about what doctors need to be interrogating—or anyone else, as I would love it if other people were involved—is, can the person understand the information? Can they retain it? Can they use and weigh it? Can they communicate their decision? If they cannot, we do not need to start mucking around with, “Why not?” It is just that they cannot, and that is the central idea of capacity. It is the functional idea, but it is tooled for use in the Bill rather than, as it stands at the moment, just being cross-referred out to the Mental Capacity Act, raising a whole series of additional complexities.
My only other observation is that I spend an awful lot of my life trying to improve Mental Capacity Act practice more broadly. I would be massively concerned were a knock-on effect of the Bill’s seeking to deal with a very specific group of people to be that it starts inadvertently—it would be inadvertent—interfering with how we think about healthcare decision making more broadly in the context of those people with impaired decision-making capacity. It is an insulation point, a making sure you have the right tools for the job point, and a not having a knock-on effect on thinking about things more broadly point. Sorry for the long answer.
The Chair
I will move on to Sojan Joseph, but perhaps you can pick this up. We have eight people wanting to ask questions and half an hour, tops.
Sojan Joseph (Ashford) (Lab)
Q
Alex Ruck Keene: I think for many reasons it can. On the pure capacity side, this is, at one level, an existential question. This is not a healthcare decision but an existential decision. The more people we have who are able to bring their different perspectives—the social work perspective on the person’s social circumstances or the medical perspective on their medical condition—the better, so that we have as many eyes on the person and insights into the person as possible.
It is about trying to make sure that the decision goes back to whether we are really satisfied that the criteria set out at the beginning of the Bill are met. I personally think we should have MDTs, for instance, as you would have in a Mental Health Act detention, so that we have more than one pair of eyes on it from more than one discipline.
Jack Abbott
Q
Sir Nicholas Mostyn: I was sort of taken by surprise when she asked the me the question in the pub, and I would not have phrased it like that in court 50.
Jack Abbott
Q
Sir Nicholas Mostyn: Parkinson’s is such a complex condition. The medically qualified amongst you will know this—there are so many symptoms, and with the rate of development and the direction of travel, it is an enormously complex condition to know. That is why it is commonly accepted that you do not die from Parkinson’s, you die with Parkinson’s, and it is almost impossible to give a mortality rate as to when that is likely to happen—almost impossible.
When I was doing my research, I was slightly surprised to see that last year 6,000 death certificates had Parkinson’s written on them. They do say that the experts in Parkinson’s are the people with it, but the people you talk to are quite clear that it is impossible to predict and it is a really complex thing. That is why this arbitrary—I use the word technically—six-month period is a problem. If a doctor opines conscientiously and honestly, unless the Parkinson’s patient has already developed pneumonia, sepsis or something of that nature, or complications from falls—the common reasons for death—you will never get that six-month ticket. That is the thing; that is the problem.
Jack Abbott
Q
Sir Nicholas Mostyn: Neurodegenerative.
Jack Abbott
Yes, those with such conditions. Are they left out of this debate?
Sir Nicholas Mostyn: They are.
Jack Abbott
Q
Sir Nicholas Mostyn: It has been suggested that I want to expand the definition of terminal illness. I do not want to expand it. I want to redefine it so that it is more appropriately focused, in my opinion, on what this Bill should be about, which is the relief of suffering. That is what I believe the Bill should be about. You should get the permission to have an assisted death if you are suffering intolerably within five months of death or seven months of death—there should not be this arbitrary line.
Moreover, it should not be open to people who are not suffering, but who happen to have a six-month life expectancy. There are probably quite a few of them, for one reason or another, whose life expectancy is short, but their pain is well-managed. I do not believe that assisted dying should necessarily be available for them. I do believe very strongly—this is not an expansion, but in my view, a more appropriate focused redefinition of terminal illness—that it should be, as in Spain and in Holland, focused on suffering.
Rebecca Paul
Q
My second question, which is completely different—just to mix it up—is on a really interesting point in your written statement about how we need to give consideration to the national suicide prevention strategy. I found that really interesting, because the Bill potentially turns on its head the way we view suicide, and obviously we have been sending a certain message out there, particularly to our young people. Could you elaborate on the point you were making in your written evidence to the Committee?
Alex Ruck Keene: Gosh—yes. There is absolutely no way that you can stop people trying to challenge whatever Act is passed; there is no way you can stop people seeking to challenge that under the ECHR. We then get into this enormous argument about whether it is inevitably discriminatory. Courts to date have been very clear: “We are not going to get into this; it is for Parliament to decide whether to make assisted dying legal.” Once it is made legal for some people, but not for others, there is a difference in treatment. Whether it is discriminatory, and therefore contrary to articles 8 and 14 of the EHCR, depends on whether that difference is justified.
I am trying to be very careful in my language, because I try to do that. The Bill Committee and Parliament need to be very clear how, if you are going to limit this to a cohort of people—I feel acutely conscious that I am sitting next to somebody who would be excluded—it could be explained to somebody that they are not eligible and that there is a difference in treatment but it is perfectly justified. If you cannot do that, it will be discrimination.
The courts have been very clear that you do not have to have a system, but if you are going to have one—for example for social security benefits—then you need to have one that is non-discriminatory. That is the answer I can give to that. The one thing I can say is that you cannot stop lawyers trying to challenge. That is what they will do.
Sir Nicholas Mostyn: All laws discriminate; 69 mph is not an offence but 71 mph is. All laws discriminate. The question is whether it is justifiable.
Sir Max Hill: It is also a question of providing legal certainty, which is why the definitions in the Bill are so important. Provided that it is articulated clearly and within what the European Court so often calls the margin of appreciation, which it gives to sovereign states, then although I agree with Alex that a challenge may be possible, I cannot see a successful challenge to the Bill if it is drawn with the sorts of provisions we have here. Indeed, we have not seen local nation state examples of this sort being struck down by the European Court elsewhere in Europe, so I think it is very unlikely that we would see such a strike-down here.
Alex Ruck Keene: I really hate to get into it with such eminent lawyers, but there has not been a case in Strasbourg seeking to say that a limited class of case is discriminatory, so we just do not know.
Sir Nicholas Mostyn: I agree with that. I have changed my mind twice about this subject.
Alex Ruck Keene: Do you mind if I quickly touch on something else?
Daniel Francis
Q
Alex Ruck Keene: I should make it absolutely clear that all I am trying to do is make sure that whatever law is passed is a good law and has as few inadvertent consequences as possible. My concern here arises out of the fact that understandably the proponents of the Bill want to make it very, very clear that this is about people carrying out a final act, and no doctor is allowed to do something that involves going beyond that. At the same time we have a situation where doctors—I am using the word “doctor” slightly loosely, but for present purposes that is what we are talking about—have to be present and have to remain with the person. We know that there will be some people for whom there are complications.
My concern is to make sure that there has been sufficient consideration given to what exactly a doctor is meant to do at that point, because it seems to me that it ends up putting the person who is undergoing those complications in a horrible position. It is also—I am perfectly happy to use this phrase—putting the doctor in a position of extraordinary moral distress. Are they at that point supposed to try and rely on the doctrine of double effect and say, “All I am trying to do is treat the complication, not bring about your death,” but the Bill is saying, “No, you are not allowed to do that”? I understand entirely why the intention is to say that the doctor must always be hands off, as it were, but you need to super clear that you are going to put some people in some very, very difficult positions, and Parliament needs to be clear-eyed about that.
Dr Shastri-Hurst
Q
Sir Max Hill: I would not look at it on grounds of discrimination. What I would do is put that clause alongside what are generally referred to as the slippery slope arguments in other jurisdictions. In other jurisdictions—Canada might be one and some of the US states might be another—the provision of life-ending medication is expressed in a form of treatment by a doctor. This is not that. We are clear when reading clause 18 that it is not a permission to administer; in fact, it is a prohibition on administration. It is making available in certain tightly defined circumstances and then standing by—not necessarily in the same room, as stated in subsection (10)—while the self-administered medication takes effect.
Having said that, I am absolutely clear that there is only so far a Bill or Act of Parliament can go as primary legislation. There is then further distance that must be covered by the provision of practical and professional rules, under the auspices of the national health service here, to indicate precisely the circumstances in which this will physically happen. I do not see that as discriminatory; we are dealing with a tight category of defined individuals to whom this applies and it does not apply to anybody outside that, as we have just discussed. But it is not prone to the slippery slope arguments of something that is generally to be made available in the course of treatment. In fact, the Bill has been couched in a very different way.
Dr Shastri-Hurst
Q
Sir Nicholas Mostyn: I did. What particular aspect do you want me to address? The range is quite wide. In relation to the administration of the substance, it is interesting that in Spain, which is now in its second full year of doing this, take-up has been extremely low. There have been only 700 requests, with a quarter denied, and a quarter of the people died prematurely. Three hundred were granted, but of those 300, in 95% of cases the substance was administered by the doctor and auto-administered in only 5%. I am trying to work out why that is, culturally, in Spain. Maybe people go when they are extremely infirm, and that is the reason for it. I am not able to see the moral distinction between having the substance administered and auto-administration. On your question, there are devices that enable somebody who is locked in to end their lives by a blink of the eyelash, aren’t there?
Sir Max Hill: Yes.
Lewis Atkinson
Q
Sir Max Hill: I would say two things. First, it bears weight that, looking at all the provisions in the Bill, the additional level of scrutiny currently being called judicial scrutiny or approval is absent in all the comparative examples around the world. That already makes this a tighter pre-legislative model than we see in other countries that have gone down this route. That is worth remembering.
Secondly, while I am not a family lawyer—I was, but a very long time ago—I think that the family division of the High Court would be very well-placed to perform the sort of exercise enshrined in current drafting, which is not a rubber-stamping exercise, but a substantive consideration of heavily objective medical opinion arrived at by not one, but two doctors, one of whom is not the treating doctor.
I listen to and accept the question of pressure on the justice system generally. That is something the Committee will be concerned about because, if the Bill passes, we want something workable. I heed what Sir James Munby said. The sitting judiciary, for good constitutional reasons, is highly unlikely to say anything. But there is therefore merit in looking at clause 12, under the heading, “Court approval”, and performing quite a simple exercise, which for me would be going through subsections (1) to (6) inclusive and, where it says “High Court”, replace that with something else. Personally, I have an aversion to the word “tribunal”, which indicates a right and wrong or some kind of fault-based system—that is not what we are talking about here. But a panel, as Nick said, is the way to go—
Sir Nicholas Mostyn: A panel appointed by the Official Solicitor.
Sir Max Hill: Whether appointed by the Official Solicitor or not. Dare I say it—because I am sitting next to a very distinguished one—I do wonder about the recently retired members of the judiciary and the role that they could play under a replacement panel system.
Sir Nicholas Mostyn: That is what I had in mind—the Official Solicitor looking at the retired judges.
Sir Max Hill: Yes, so there is legal professional capacity among the retired judges—not that they would sit alone on a panel. It would bring with it the extra benefit of having suitably qualified medical professionals, like the Spanish model. So yes, I think that could be done. That is not the same thing as saying that the High Court approval model is fatally flawed and could not be introduced, but I do think there is a viable alternative, which is worth looking at.
Alex Ruck Keene: I have only one observation, and I said this in my written evidence but I also want to say it out loud. You have to think very carefully about what purpose any form of this oversight is actually serving societally, if the oversight panel, whether that be a judge or a panel, cannot decline to approve an application if it considers that the reason the individual is seeking assistance in dying is because of service provision failures by the statutory bodies responsible for meeting their health and social care needs. That is a question of principle, and I want to make sure that that is squarely before you.
Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
Q
Alex Ruck Keene: We have capacity, but we also have to make sure that it is settled, informed and voluntary, and that we do not have things like pressure or influence going on. It is important to make it clear that we are not just saying that this is about all the weight going on capacity. For instance, if you have social workers involved—if you have, say, palliative care social workers involved, assuming it is a palliative care situation—they are going to be far better informed about what options might be out there than a doctor, potentially, depending on the doctor. Social workers more generally might well have more expertise in picking up signs of coercion or influence than a doctor, but I do not necessarily want to get into, “Some disciplines are good at X” and “Some disciplines are good at Y”—I have come across brilliant examples and bad examples in both zones.
It is partly about multidisciplinariness and also about the fact that you have more than one person trying to talk it through. When I train, I always try to tell people that 85% of capacity assessments are not all that difficult —they are just made difficult because you do not have time or you are not listening—but 15% are more difficult. I think a lot of these will be in the 15% zone, and in that zone, the more people you can have thinking about it, so long as they have an agreed framework within which to think, the more reliable, transparent and accountable the outcome is going to be.
The Minister of State, Ministry of Justice (Sarah Sackman)
Q
Sir Nicholas Mostyn: The former.
Sarah Sackman
Q
Sir Nicholas Mostyn: It will have the statements in schedules 1 to 4, signed by both doctors twice. This is where it gets slightly tricky. Is the panel expected to be a ferret and say, “This does not quite chime for me”? The Committee will have to consider how investigative the panel will be, or whether it will purely sit back, be passive and work on the material it has. Of course, under clause 12, it has to hear orally. That might get the alarm bells going, but I believe that the panel should be entitled to call for further evidence if it has concerns. As I say, I have been trying to find out why 10% of cases were rejected by the panel in Spain. There must have been some kind of procurement of further evidence by the panel in order to do that.
Sarah Sackman
Q
Sir Nicholas Mostyn: Article 10 of the Spanish law gives an appeal on a point of law to their high court, so I would have the same, with an appeal on a point of law to the High Court, but only on a point of law.
Alex Ruck Keene: Either way—it would have to be either way. It could not just be against a decision not to approve, logically, because the current model is very odd in saying that you can only appeal one way to the High Court.
Sir Nicholas Mostyn: Yes. Spain gives either side the right to appeal, so I agree with that, but it is confined to a point of law.
Sir Max Hill: I would only add that I wonder whether that is the only route through, namely leaving open a judicial review appellate process, or whether, for example, as we imagine with a number of commissioner-led processes already in this jurisdiction, the panel—or frankly, I suspect, panels, which might sit regionally, chaired perhaps by the retired judiciary—would have an appellate route to a national body, which you could call a national commission, instead of a judicial-review route to the Court.
There are a large number of commissioners, some sitting under the Home Office and some sitting under the Ministry of Justice—in a sense, I was a commissioner when I was the independent reviewer of terrorism legislation—with closely defined powers. There are many others who sit in an enhanced regulatory position—highly qualified individuals. You could describe them as national commissioners, if that is an appropriate term, and they would have superintendence over regional panels, and the power to appoint retired judiciary, perhaps with the assistance of the Official Solicitor, to sit on those regional panels, and then to have an internal appellate mechanism.
Sir Nicholas Mostyn: You have to have an appeals process of some type, because otherwise there will be judicial review. If there is no appeal, there is judicial review—so you have to have an appeal of some type or there will be judicial review.
Sir Max Hill: Yes, I agree.
The Chair
We have some Members who want to ask more questions; we have about six minutes or so. Jake Richards, you did have a possible question earlier on.
Jake Richards
Q
Sir Nicholas Mostyn: Relations who say, for example, “My father has been pressured by his new wife to do this”. If a father has given permission and the child has asked to intervene, there would be some process where the child would be allowed to become a party to the proceedings, because that will have to be specified in rules, and that person would then be the appellant.
Jake Richards
Q
Sir Nicholas Mostyn: Well, it does.
Jake Richards
It is an autonomous decision, so—
Sir Nicholas Mostyn: No, but it says, procedurally, they can determine their own procedure.
The Chair
Order. I am giving you an opportunity to ask a question, so ask the question, we will get the answer back and then we can move on. I do not want this dialogue, I am afraid.
Jake Richards
Forgive me, Mr Dowd. I meant that, in terms of the assisted dying process in the Bill, there is no automated mechanism for family members, or indeed any third parties, apart from the doctors, to have notice of this intention. Is there a concern, regarding this appeal point, that perhaps interested parties would not know?
Sir Max Hill: I would suggest that the key to this is in clause 12(5), and that is why I have recommended just striking out the words “High Court” and putting in the word “panel”, and then reading the whole of clause 12 as amended, with those situations in which there are steps that “must” be taken—and there are many—and those in which there are steps that “may” be taken.
In clause 12(5), following that logic, we would imagine that a panel, just as the High Court,
“may hear from and question, in person, the person who made the application”
but
“must hear from…the coordinating doctor”.
The appellate mechanism, which I agree there needs to be, will be looking sharply at the operation of that subsection. In other words, when the panel made its decision to refuse, on what basis did it make that decision and from whom had it heard? We can well imagine situations in which a co-ordinating doctor, having taken his or her own steps to ascertain the views of the nearest and dearest, would satisfy the panel as to what the views of the family are. The reverse of that is that there is no indication here that, having gone all the way through the panel, the family would have been made aware or considered at all. I think that that will be a rare scenario, but I am not a medical professional. I think you can cover that, perhaps with some changes here or there on what you impose on the panel as a mandatory duty and what you leave by way of discretion, subject to the rules of procedure that the panel would then adopt.
Dr Tidball
Q
Alex Ruck Keene: This is, for the moment, predicated on the fact that we are still in the High Court, as opposed to slightly making up policy on the fly about a panel. Assuming it is the High Court, it seems to me the Court has to be discharging a properly inquisitorial jurisdiction, which means it has to be armed with the tools to do that, which includes arming it with the tools to call for its own evidence. It also seems to me that the High Court would have to be armed with its own ability to not just receive evidence from one side and have someone testing it. That then brings you to the only player in town who could possibly do that, which would be the Official Solicitor as advocate to the Court.
I do not want to emphasise too much the question of resources, because if Parliament thinks this is sufficiently important, the resources will be voted through. But it is vitally important to note that the Official Solicitor is completely overloaded, and we would be asking the Official Solicitor to act as advocate to the Court in every single one of these cases. You could not have it be optional; you cannot say that it is some and not others. If it is going to be inquisitorial, the High Court has to have the ability to say, “This is one-sided; someone needs to tease it out,” so the Official Solicitor would have to be funded to be advocate to the Court and, if necessary, instruct lawyers in every single case.
Sir Max Hill: The model that I was espousing would not necessarily involve the Official Solicitor at all. It would make no draw on the administration of the Court or any officer of the Court, still less full-time judges. It would allow the appointment of recently retired judges, as we have in a number of scenarios—surveillance commissioners, for example—and a fresh administration. With that, as with the High Court model at the moment, there is the primary set of provisions, which Parliament must impose, and it is important that that is sufficient for what Alex called an inquisitorial function. Those are in part mandatory—those things that the panel must be satisfied about, which are set out in clause 12(3). Then there are those that are discretionary, which are set out in clause 12(5).
What sits between the two is very important. That is currently expressed as “Rules of Court”, but it would be the rules of the panel, or the commission that appoints the panels. In a court scenario, we are all familiar with criminal procedure rules and civil procedure rules; that is the secondary stage that is reached once the primary legislation has been fixed. That, too, would apply to the commission or panel process, but I do not necessarily think that it would involve using existing, paid judicial resources at all.
The Chair
We have one and a half minutes, so it will be a 10-second question and a 20-second answer; unless you can do that, I am going to call it to a close.
Dr Opher
Q
Sir Nicholas Mostyn: I would frame the law to define terminal illness in the way that it is defined here in clause 2(1)(a), but where the “person’s death in consequence” is referred to, I would delete clause 2(1)(b) and substitute “suffering intolerably”.
The Chair
Thank you. That brings us to the end of the time allotted for the Committee to ask questions. I thank our witnesses on behalf of the Committee; thank you for your forbearance.
Sarah Olney
On a point of order, Mr Dowd. I had my hand up at the beginning. I was really keen to ask a question in this session because it is pertinent to an amendment that I have tabled. Could you advise how best I can have the opportunity to ask my question?
The Chair
I am more than happy to speak to you afterwards. We have had lots of questions today and I tried to get people in as much as possible, but there has to be an element of self-discipline from the people asking the questions and interrupting. I am happy to facilitate if I possibly can, but I am afraid that there is also a responsibility on Members to look to other Members’ needs.
Examination of Witnesses
Dr Ryan Spielvogel and Dr Jessica Kaan gave evidence.
The Chair
We will now hear oral evidence from Dr Ryan Spielvogel, who is senior medical director for aid in dying services at Sutter Health, California, and Dr Jessica Kaan, who is medical director for End of Life Washington. Both witnesses will appear via Zoom. I call on Members to ask questions, but in view of the last point of order, I must be absolutely clear that I will interrupt if questions to the witnesses are too long. We do not have much time and people want to get their questions in—there has to be an element of self-discipline in that regard.
Kim Leadbeater
Q
Dr Spielvogel: Thank you all for having me today. I am Ryan Spielvogel and I am senior medical director for assisted dying services for Sutter Health in California. I have been an assisted dying physician for the past eight and a half years, since the law went into effect here, so I have seen many terminally ill people going through the process.
You asked specifically about coercion and capacity. Determining mental capacity is something that we use physicians to do every day. There are codified steps and processes for us to be able to assess a person’s capacity. Capacity for anything, for any procedure or medical intervention, is presumed—that the patient has capacity—until they are deemed to not have capacity. We do that through asking questions, determining their understanding of their disease process, asking them to repeat what their understanding of their options is, and making a decision and then telling us their judgment as to why they came to that decision.
That is something that we do every day. It is oftentimes informal. For instance, if I am prescribing someone blood pressure medication, I might not go through the entire process of assessing capacity, but in longer or higher-stakes conversations like end-of-life discussions, I usually do ask somebody to repeat back to me what they understand of their disease process, their options, what their decisions are and why they are making those decisions. That is basically exactly what I do in these conversations.
In terms of coercion, I understand the concern. It is a very valid concern that people have. I have seen this in many jurisdictions in the US, where different states are considering legalising assisted dying, but I will tell you that in practice it just does not happen. I have seen assisted dying laws go into practice across numerous states and have helped many, many people through this process, and I have never seen a case where I even suspected coercion. People are just not that good as actors.
So we get the family out of the room. We dig deep into their concerns, their justifications and the reasoning behind their choices. It is often crystal clear, when you are speaking to someone who is suffering from a terminal illness. They are very focused on their symptoms, very focused on their quality of life, very focused on their suffering. I do not ever get the sense from them that their family, their doctors or anybody is coercing them into the decision. In fact, if anything, I have seen it many times the other way around. I tend to see it where the patient is really ready to let go, but the family is really not ready to let go, and the family puts up varying degrees of roadblock to the patient accessing assisted dying. I have seen many cases of people being coerced out of it; I have never seen someone being coerced into it.
Kim Leadbeater
Q
Dr Kaan: I echo exactly what Dr Spielvogel has said. As part of our medical training, we are trained to assess capacity in both small and big ways, depending on the size of the decision at hand, as he said. Throughout our medical training, we are trained to do that and to assess with a patient progressively over time, as we are seeing them in subsequent visits as well. This is really no different from that, although obviously the stakes are a bit higher than a blood pressure medication discussion.
We look at whether, for instance, the patient is able to voice a reason for making their decision. Do they have a logic behind it? Do they have a set of values that they can express? Is their decision consistent over time? We are looking at a longitudinal assessment, rather than just one fixed moment in time. Over the course of our assessments, it really does become clear in almost all cases that somebody either does or does not have the capacity to make this decision or any decision. This is really not outside the realm of what physicians are trained to do in any other case of medical decisions, especially large ones.
In the case of coercion, I agree that virtually all the time it is the opposite way: family members and loved ones are well-intentionedly trying to coerce or convince someone not to make this choice or not to proceed with this option, which they may have available, rather than pushing them to do it. I think the way to properly assess that is to ask open-ended questions: as Dr Spielvogel has said, to have them in the room alone, at least for a portion of the assessment, so you can have a one-on-one conversation; to ask the questions in various ways, so you are seeing the consistency of answers over time; and to look for non-verbal cues that may indicate that something else is going on. I have also never come across a case where I felt that a patient was being coerced into this decision by a family member, but rather the opposite.
Bambos Charalambous (Southgate and Wood Green) (Lab)
Q
Dr Spielvogel: The original version was called the End of Life Option Act. It legalised assisted dying in California when it went into effect in 2016. It was then amended in 2021, I believe; the effect of the main amendment was to shorten the waiting period. There was a 14-day mandatory waiting period between two verbal requests that a patient would give directly to their physician. What we found when we were studying it was that approximately 30% of people died during the waiting period.
There were many conversations with patients. The thought process behind the waiting period is that somebody is making a persistent, well-thought-out and non-capricious decision when they are asking for this, but there is a false premise there—[Interruption.]
The Chair
We were in the middle of your reply, Dr Spielvogel. Could you pick up where you left off?
Dr Spielvogel: I will make it brief. I was saying that it is an erroneous assumption that people start thinking about assisted dying the first day that they give their first verbal request. In reality, people have usually been thinking about it for weeks before that visit. Because of that, we did not see anyone’s decisions really ever change between the first verbal request and the second, 14 days later. That and the fact that 30% of people were dying during the waiting period led us to shorten the waiting period to 48 hours. That is the main change that we have had in our law since it was implemented.
Bambos Charalambous
May I put the same question to Dr Kaan?
Dr Kaan: You will know that throughout the United States there are a variety of aid in dying laws, all of them slightly different across jurisdictions. I practise in both the state of Oregon and the state of Washington, so I have to keep track of two slightly different laws.
In the state of Washington, where I am the medical director for End of Life Washington, we updated our law in 2023, mostly because we were trying to increase access to it for people who lived in rural communities or for people in underserved communities. Any healthcare system in the world right now has experienced a shortage of physicians, so the requirement for two physicians to do the certification was a barrier for people in those communities that did not have access to two physicians. One of the things we did to increase access in 2023 was to make it so that one of the two providers could be a non-physician: a physician assistant or a nurse practitioner with advanced training. One of the providers still needs to be a qualified physician, but that has increased access for those in rural communities and underserved communities. We are very proud of the fact that we have done that. Additionally, we shortened our waiting period for similar reasons, from 15 days down to seven days.
In Oregon, they shortened their waiting period. Well, they still have a 15-day waiting period, which has been stable since the start in 1997, but they also now have a provision whereby, if a patient is expected to die within those 15 days—if they are at the very end of their life and are not expected to be able to survive those 15 days—they can bypass the waiting period. I really like that provision, because there are patients who come very late in their process to this decision. It may not seem like much to us, who are healthy and relatively well, but 15 days for a dying person who is suffering and really wants this option is an incredibly long time.
Tom Gordon
Q
Dr Spielvogel: People often feel that at the end of life, just in general. I think that conscientious people will often think about their family and how their situation is affecting their family and loved ones. That is something that many people go through, so that is something that comes up relatively frequently. It is usually embedded within a laundry list of reasons that people are looking for assisted dying. When people bring it up with me, it is more of a commentary on what they do not like about their dying processes—that they are also feeling like a burden on their family. That is a red flag for me, though: when I ask someone, “Why are you reaching for this?”, and they say, “Well, I am a burden to my family,” it is a red flag for me as a physician.
This goes back to the argument about capacity and coercion, because we are trained professionals who listen for these things. This is not a rubber-stamp evaluation. When we ask people why they are looking for this, we really want to assess their judgment and see what their reasoning is. If they are saying, “I’m suffering intolerably. I’ve tried all the things that palliative care and my regular physician are offered me, but I’m still suffering irrevocably. Also, there is this other piece: I see what this is doing to my family,” that is totally valid. That is something that any of my dying patients might say, whether or not they are seeking an assisted death.
If that is the only reason, that is going to lead me to ask a lot of probing questions. It would be a red flag for me, but it is incredibly rare that something like that would be the only reason. Dying is a very complex process, and people’s thought processes during their own dying are equally complex. There are a lot of things that people think about during that time.
Dr Kaan: I echo Dr Spielvogel. It is common that among the lists of things that people mention as reasons, they may mention not wanting to be a burden on their families or not wanting to put their families through an onerous and prolonged dying process. Obviously, if that is the only thing that they are mentioning, it will definitely get them further discussion and exploration into what is going on and what other resources we can point them to, such as connecting them with social workers and available community resources for helping with caregiving.
However, I hear most commonly that people’s desire to save their families from a prolonged dying process comes from lived experience, where they themselves went through the process with a loved one such as a mother or father: they were caregivers, sometimes for years, and felt that it was a burden on them, although they were happy to do so and it was loving. They have that lived experience and they are looking to save their family from what their experience was. I think it is common that people feel some element of that when they are in a situation where they require heavy caregiving.
I think it also goes back to autonomy. People who are in their right mind and have the capacity to make this decision should have the autonomy to have their reasons and their value systems respected, whether or not we share them or see it in the exact same way.
Jack Abbott
Q
Dr Kaan: The thing I have been reading about that is concerning to me is the court approval that you seem to have written into your law. I heard your discussion this morning about how that might be done and whether it is a committee or the High Court and so on. I think that that is really going to limit access to this, and that makes the process a much lengthier one.
Again, these are people at the end of their life. People are not looking, by and large, to cut off a huge amount of their life; they are looking to shorten their death, not shorten their life. By making people go through a court appeal in addition to two qualified physicians, as well as the waiting period, I think that you are going to limit access for people who desperately want this option. It seems like that might be baked into your law, but I would say that that is a concerning feature to me. I think that you are going to limit access that way.
Dr Spielvogel: Something that it turned out was not in our law, but everyone thought that it was for a few years, and it really limited our practice, was that many people were under the impression that the physician could not bring up assisted dying with the patients, and that the patients had to bring it up themselves. That turned out not to be in our law, but that idea really hampered our ability to take care of patients, so I would strongly recommend that there not be anything like that in your Bill. People cannot make informed decisions for themselves if they do not know what their options are. While this is top of mind for all of you and for the doctors—we all know that this exists—even if this Bill becomes law, the general population is still not going to realise that it is an option.
I eat, sleep and breathe this. I am a primary care physician, and when I am going through the options with patients who are newly diagnosed with a serious life-threatening illness, I say, “Okay, here’s what disease-directed treatment would look like. We can continue with your chemo. Here are some side effects and complications that you might have, and here are the benefits of that. Here’s what palliative care or hospice care would look like.” Then I say, “I don’t know if you know this, but in our state we have this other option for people nearing the end of their lives when they have intolerable suffering. You can ask me to fill a lethal prescription for you to help end your suffering sooner.”
The number of times that people look at me and say, “You can do that? That’s an option here?” is astounding. I would say that nine out of 10 of patients I have conversations with have no idea that that is even legal. If they do not know it is an option, they are never going to ask for it. For physicians to do their jobs properly and deliver care to people, and for people to actually have a choice, physicians need to be able to discuss it with their patients.
Dr Kaan: I will just piggyback on that. I cannot count the number of times I have given a presentation or a talk to communities, and people—usually family members of someone who have died, not using this law—have come up to me afterwards and said, “Thank you for what you said. My loved one was interested in having this information, or wanted to talk to their doctor about it, but their doctor never brought it up, so we weren’t sure if we should be bringing it up.” It is a huge burden to put on patients and their loved ones if they have to bring it up themselves. I would highly caution against any sort of language that requires that, because it is just not fair to them. They are already going through so much and, as Dr Spielvogel said, you cannot have an informed decision-making discussion with a patient if they do not have all the options available for discussion.
The Minister for Care (Stephen Kinnock)
Q
Dr Kaan: That is a really important question, because this is a really important topic in the United States. Our laws are very clear that participation is voluntary, so there is no such mandatory training across medical training in general. It is always voluntary. If a physician or provider wishes to have training, they can seek it out. What is available and the standard of care differ from state to state. Certainly, in the state of Washington, where I am the medical director of the organisation that is most largely involved with this, the bulk of my job is doing training, mentoring and shadowing. There is no exam at the end of that process, but there is certainly shadowing and a feedback process.
I am also heavily involved with the Academy of Aid-in-Dying Medicine, which has been very active in creating professional training. We have a Journal of Aid-in-Dying Medicine, which is a peer-reviewed journal that puts out articles that are relevant to the topic. The Academy of Aid-in-Dying Medicine is now undertaking certification pathways, so each level of provider—social workers, chaplains, physicians and anyone else who might be involved in the aid-in-dying process—will be able to take these certifications. A more uniform education system will be available. We are just at the beginning of creating those, but it is very exciting, and we are very happy to have those out. A lot of resources are out there in the world already, in general, to train providers in how to do this well, and it would be really smart to have something in your Bill that outlines what the training should be, whether you will make it mandatory or voluntary and perhaps some sort of certification pathway.
Stephen Kinnock
Dr Spielvogel, I do not know whether you have anything new to add to that. If not, that is fine.
Dr Spielvogel: Without repeating anything that Dr Kaan said, I was just going to say that in addition to my assisted dying hat, I am also the programme director for the family medicine residency programme, so my main job is actually training young physicians who are becoming what you would call GPs.
We have instituted curricula as part of our residency programme here to train interested physicians in learning how to do assisted dying. We go through a whole process for that, including lectures, them shadowing me and me shadowing them, listening in on their conversations, giving them pointers and walking them through the steps of the process. They then do this with multiple patients through the course of their residency, so when they graduate, they feel confident in being able to offer this care. As with most medical training, this should be included in that part of the training process. All the other things, such as pathways in continuing medical education, are very important for physicians out there in practice who want to start doing this, but really getting this into medical training at its roots is vital for normalising the practice.
Speaking of which, something else I have heard a lot is that this might be distressing to physicians, or that physicians would not want to offer this care. I would like to say that 80% of our residents on our programme opt to receive this training. When we did a study on this of graduates from our programme who were continuing to offer assisted dying, 70% of the surveyed residents said that their assisted dying work was more rewarding to them than the rest of their primary care work—70% said that it was more rewarding.
I want to come back to the notion that physicians would feel burdened or that this would be some sort of psychological negative to physicians practising it, because it is actually quite rewarding work. It has led me to be a better physician to all my patients because it has helped me with having these difficult end-of-life conversations with them. That was a bit of a twofer, sorry—I added that on there.
Danny Kruger
Q
Dr Spielvogel: A lot. I have actually been quite surprised. Everybody is different. This is the whole point: different people have different goals, objectives and values. I have mentioned it to people who say, “No, I would never do that,” and I never bring it up to them again.
The Chair
Order. Do not interrupt the witness, please. Let him finish. You can then come back in with a question.
Danny Kruger
I apologise.
Dr Spielvogel: No problem. To answer your question more directly, I have had several people over the past couple of years who had no idea that it was an option and said, “That’s what I want to do.” They then went through the process with me.
Danny Kruger
Q
Dr Spielvogel: Yes. I think it could be made into a misdemeanour, a felony or whatever the equivalent is over there—sorry, I do not have the terminology. You could make it illegal to interfere with a patient’s right to make this choice. We stopped short of that in our most recent addendum to our law here, but I think that was a lost opportunity.
Danny Kruger
Q
Dr Kaan: You characterised it correctly in that I think that for people who have capacity, and who are making the decision to have this as an option, a part of their reasoning is that they want to save their family from an onerous caregiving experience. I think that is their right and it is part of their value system.
Of course, if that is the only reason, we are going to be exploring that. As Dr Spielvogel has said, that is a red flag. We are going to be exploring that, and exploring whether acceptable alternatives exist and what are the resources that the person may not be aware of. That is always part of the discussion. These discussions are always broad and multifactorial. But I think it is appropriate and okay for somebody to say, “I do not want my family to experience what I myself had to experience when I was caregiving for my elderly parents with dementia.” I have heard that many, many times. I do think people who have capacity should have their autonomy respected, in terms of the values that are driving them to make this decision.
We always want to work towards improving the social support for caregiving that exists in our society. There is certainly a lack of it here in the US, and probably there in the UK as well. Hand in hand with allowing people to make an informed decision about the option of having an assisted death, you should also be a strong advocate for social support and caregiving services at the end of life, because those really are important and needed.
Naz Shah
Q
Dr Spielvogel: That is a good question. I do not know the specific status of the Bill, but I would assume that it has itself undergone an assisted death at this point. That Bill is not really being supported by any of our advocacy groups or, by and large, the physicians who perform assisted dying, because it is, as you mentioned, very broad and not aligned with how we feel standard practice is going and where we would want it to go. That Bill did not receive support from many of us.
Naz Shah
Q
Dr Spielvogel: Can you clarify what you mean about kidney disease and the six-month prognosis, and the interplay with insurance there?
Naz Shah
Q
Dr Spielvogel: That is not factually accurate. When people go on dialysis, they automatically get Medicare, which is our version of the NHS, more or less. That is a national health insurance for people who are 65 and older or who have certain kinds of diseases. When you have end-stage kidney disease and you need dialysis, you automatically get Medicare and you get dialysis for the rest of your life, however long that is. People are often on dialysis for years. It is not that you are on it for six months and then you are off.
Naz Shah
Q
Dr Spielvogel: If you have a six-month prognosis to live, regardless of the condition, that would fall under this. That would make you eligible. That has nothing to do with insurance coverage for your condition. Insurance coverage is completely separate. It is not tied to this. All that prognosis does is to allow the individual to seek this care.
Naz Shah
Q
Dr Spielvogel: No. Insurance does not run out. There is maybe a misunderstanding of how medical insurance works in the US. Medical insurance does not run out. I think we are talking about two different things.
Naz Shah
Q
Dr Spielvogel: No, I actually do not think that you are right. When we are talking about lifesaving interventions such as chemotherapy or dialysis, that is not correct. They are bound by law to cover all things that are medically necessary. They do not say, “You have gotten six months of chemo. We are not paying for any more.” That is not how it works.
Sean Woodcock
Q
We heard from experts earlier about the paucity and lack of provision of care across the country. Certain people can get access to very good care, but too many people struggle to, particularly people of certain ethnic backgrounds, people on low income, and so on. Please correct me if I have misinterpreted your views, but from what you have said so far, it sounds as if you think that exercising the right to assisted dying because there is a paucity of appropriate care in your locality, or because you cannot afford it, is a perfectly legitimate exercise of autonomy, based on the society around you. Would that be a fair assumption of your views?
Dr Kaan: I think that is not an entirely fair representation of what I am saying. Yes, we do need respect for people’s autonomy and the reasons they may come to this choice, but I also think that from what I have heard this morning, it sounds like there is a conception that people choose assisted dying and then they do it. What I see, by and large, is that people want to have this as an option. It is an option among the other options of hospice palliative care or palliative treatments. The availability of this as an option often brings people tremendous relief from their suffering—just from the anxiety over how they might die, or what suffering might be in store.
I had a case of a woman with ALS, or amyotrophic lateral sclerosis. She was very afraid of how she might die with that condition, and she felt like she might suffocate to death. She was so focused on having the option of aid in dying because she was terrified of what might be in store for her. We were able to incorporate her into a hospice that offered comprehensive end-of-life care, including the option of aid in dying. We got her through the process, we had the medications available and she told me how much relief she felt from having it as an option, but ultimately she decided not to use it. She decided that she was getting really good care from her palliative care and hospice teams, and that her symptoms were well controlled. Although she was extremely grateful that she knew the medications were available should she decide to use them, she did not end up needing to use them or wanting to use them.
That is the reality of what is happening in a lot of cases where this is an option among other options. The availability of this option is, in and of itself, a palliative care treatment for many people. On whether or not wanting to avoid being “a burden” to a family member or to a caregiving team is a valid reason to pursue this, yes, I think that is a valid reason among many for people who have a value system that highly orders that.
Dr Spielvogel: I just wanted to add something, if I may. I have heard this argument—or rather, this concern—a few different times, and it strikes me as what is called a false dilemma logical fallacy: that there is either/or, when in reality there are many alternatives that people can choose from. Saying “If we don’t have all of these types of care, we shouldn’t offer this option” is like a hospital that does not have sufficient amounts of IV pain medications saying to a labouring woman, “Well, we don’t have enough IV pain medications, so we are not going to offer you a labour epidural, because that is a false choice.” That does not actually make sense.
Look at it from a patient’s perspective. Think about a patient who is dying from terminal cancer, is in lots and lots of pain and does not have any good options for their pain control. Imagine saying to that person, “We don’t have all of this care or this option over here available to you, so we are not going to allow you to have an assisted death”, even if they are telling you, “This is what I want. Why won’t you give this to me?”. It does not make sense to remove this as an option just because all of the options might not be available to everyone all of the time. It is a bit cruel when you think about it from a patient’s perspective.
The Chair
We have two minutes left before the evidence session finishes. Dr Simon Opher, please ask a very quick question and perhaps we could have a short response. I do not want to interrupt our witnesses at the end.
Dr Opher
Q
Dr Spielvogel: I literally had not formed any kind of opinion on this. When I was in medical school, it was not talked about. We did not talk about it; we did not discuss it; it just literally was not a thing, and then when it became law in California, I still had not really thought of it until my medical institution asked me whether I wanted to participate. I said, “Sure, I will give it a try,” and then with my first patient, I saw how amazingly transformative it was for him and his family. I had seen lots of death before then; I saw how tragic and traumatic it often was and how this was a dramatically different experience, and I became a convert.
Since then, I have seen many other physicians undergo the same journey with their patients. They have been very ambivalent to it until they have a patient who is asking for it. They go through it with that patient who they have known for a long time, and then they come out on the other end realising just how amazing this option is to the people who want it. Again, I am emphasising that this is a choice. For people who do not want this, they do not need to have it. For doctors who do not want to do it, they do not have to do it. But for the patients who want this, it is an incredibly powerful piece of agency.
Dr Kaan: The jurisdictions I work in have quite a bit more experience. In Oregon, of course, it has been legal since 1997, and it has been legal in Washington state since 2008. Both of those laws were actually started by voter referendum, so the general populace at large wanted this, and that is how these laws got started in both of those states. The general population has, by and large,, been supportive, and is growing more and more supportive of this as an option each year as it becomes normalised and clear that this is a practice which is careful, safe and has appropriate safeguards in place.
The medical community has also come along with that. In Washington state, we have now 15 years of practice with assisted dying. When this law was first passed, there was hesitancy in the medical community: this was an unknown, in many regards. We were the second state in the entire United States to pass this law and so the medical community was a bit hesitant. I will say that, in those last 15 years, we have seen a tremendous growth in the support of physicians and the medical community at large in wanting to make sure that this is an option for people and that they have access. Just in my own experience in Washington state—
The Chair
Order. I am sorry; I hope this does not sound rude, Dr Kaan —regrettably, there are procedures in Parliament that require me to do this—but we have come to the end of the allotted time for the Committee to ask questions. I thank the witnesses Dr Spielvogel and Dr Kaan for your contributions and time. This was very valuable.
Thank you to our witnesses and for all the contributions, and for your forbearance on this very sensitive subject.
Danny Kruger
On a point of order, Mr Dowd. I wonder, given the fact that we have had so many really helpful conversations and questions but not enough time for everybody to ask everything they wanted, whether it would be appropriate for Members who want to write to witnesses to ask for follow-up information or further questions could do so through the Committee, rather than us all deluging the witnesses with our own messages, some of which will duplicate each other. I appreciate that there is a capacity question for the Clerks, but it might be appropriate to ask the Speaker for a bit more resource to enable that to happen. I think that the hon. Member for Spen Valley broadly supports the idea; I do not know if others do, as well.
The Chair
Let us be clear. Witnesses can submit written evidence until the Committee reports to the House. It is open to Members to individually write to witnesses and invite them to give written evidence, if they so wish. My advice to the hon. Member is that if he wishes to look at this in a more formal way or through a more formal mechanism, he is to speak to the Committee Clerks, because it is beyond my remit.
We now come to motions (a) to (d) amending the sittings motion tabled by the Member in charge. I have selected the amendment tabled to motion (a) and will group all four motions and the amendment for debate. I will first call Kim Leadbeater to move motion (a), then Naz Shah to move the amendment. The scope of the debate is all four motions and the amendment.
Kim Leadbeater
I beg to move amendment (a), in the list of witnesses set out in the table in the Sittings Motion agreed by the Committee on 21 January 2025, after Mencap (Thursday 30 January, until no later than 5.00 pm), leave out “Representative of Senedd Cymru” and insert—
“Professor Emyr Lewis (Emeritus Professor, Department of Law and Criminology, University of Aberystwyth), Royal College of General Practitioners, Royal College of Psychiatrists.”
These amendments allow additional witnesses to be called to give oral evidence, including representatives from Disability Rights UK, the Royal College of General Practitioners, the Royal College of Psychiatrists, and an expert in Welsh devolution and constitutional matters.
As the sessions today have shown, hearing from expert witnesses is an extremely important part of this process, so I hope I have the support of the Committee in making these additions. On the motion to call additional witnesses tabled by my hon. Friend the Member for Bradford West, I respect the suggestion but I am confident that we have an eminently qualified witness to cover issues of coercion and domestic abuse in Professor Jane Monckton-Smith, who was suggested by my hon. Friend.
We have also heard today—and will hear from many witnesses over the next few days—from medical doctors, social workers, nurses, palliative care experts and geriatricians. That is around 50 witnesses in total. While I fully appreciate that a wide range of additional charities and organisations has valuable contributions to make, I would encourage them to submit written evidence so that the Committee has the benefit of their thoughts.
Regarding the start of the line-by-line scrutiny of the Bill, given the huge volume of evidence—both oral and written—that we have received and are still receiving, I have consulted with colleagues across the Committee and there is a consensus that having next week to absorb and evaluate the evidence, and to prepare any amendments in light of it, is extremely important. Consequently, we would begin line-by-line scrutiny on Tuesday 11 February, as per the amendment.
I hope that these amendments demonstrate the robust approach that the Committee and I are taking to our work, and I encourage colleagues to support them.
Naz Shah
I beg to move an amendment to amendment (a), at end insert—
“Richard Robinson, CEO of Hourglass, Cherry Henry-Leach of STADA, Standing Together Against Domestic Abuse ”.
I completely agree with my hon. Friend the Member for Spen Valley and I am grateful to her for adding Professor Jane Monckton-Smith to the witness list. I also absolutely agree that the evidence we receive is really valuable.
This is an amendment tabled yesterday by the Mother of the House, my right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) yesterday, to which I have added my name.
The reason for the amendment is that Hourglass focuses on domestic abuse of older people and it has particularly noted that the majority of such victims are female. Hourglass estimates that one in six elderly people are victims of coercion in the UK. This raises serious concerns that such people could be pushed into ending their lives if the Bill is enacted. Hourglass has not published a public opinion on the Bill.
Standing Together Against Domestic Abuse has said that
“We must echo concerns raised by the VAWG sector”—
the violence against women and girls sector—
“and disability activists about the bill’s current safeguards. There is insufficient clarity on what constitutes coercion and limited reflection on carer capacity to support someone terminally ill. Without robust measures, there is a real risk that assisted dying could be exploited as a tool for coercion or even femicide.
Statistics show that over 88% of unlawful ‘mercy killings’ are perpetrated by men towards women, often involving violent means. These troubling realities demand urgent consideration in shaping this legislation.
We also highlight the health sector’s role in identifying domestic abuse. With 80% of victim-survivors having their first or only point of contact in healthcare, it is critical that health professionals are equipped to identify and respond to abuse.
We call on the Government to ensure the proposed bill includes stringent safeguards and that healthcare systems are equipped to recognise and prevent the potential misuse of assisted dying. Femicide is already a crisis in the UK, and no law should inadvertently contribute to its escalation.”
All my adult life, I have had experience of dealing with domestic abuse and coercion, and I draw on that experience to speak to these amendments. Although Professor Jane Monckton-Smith is an expert, she is an academic. These two organisations work with people who have been victims of abuse.
In addition, we had an official meeting with the Clerk to discuss the proposals for Committee sittings. It was said at that meeting that we would only have witnesses who would give evidence, particularly in person, that would contribute to the deliverability and the workability of the Bill. Since then, we have had families added to the list of witnesses. That adds weight to the argument that we should have witnesses who are providing a service to victims directly.
Dr Tidball
I, too, support my hon. Friend the Member for Spen Valley and in particular I want to highlight the helpful addition of Kamran Mallick of Disability Rights UK. That augments an already comprehensive list of expert disabled people, which includes: Professor Tom Shakespeare, an internationally renowned disability rights academic; Dr Miro Griffiths, a Disability Studies scholar at the University of Leeds; and Chelsea Roff, the founder of Eat Breathe Thrive. On the panel, we will also have a representative of the Equality and Human Rights Commission, who will be able to give a good overview on the intersection between protected characteristics. Finally, there will be Jon Sparkes, the representative of Mencap.
I am really pleased that my hon. Friend has worked so hard to ensure that the voices of disabled people are integrated across a number of the panels that we will see over the next two days, and the addition in her amendment is really helpful. I commend her for it.
Kit Malthouse
I, too, support the amendment proposed by the hon. Member for Spen Valley, and in particular the addition of Jane Monckton-Smith. I have read her book; it is definitely worth a read and is pretty alarming. I will address why I do not think the Committee should support the amendment to the amendment tabled to add other witnesses.
Jane Monckton-Smith has done a huge amount of research in the area, and as well as being an academic who specialises in coercion and femicide—and the impact that coercion has on femicide—she is a former police officer, so has significant frontline experience. As part of her research she will have spoken with and interacted with many of the groups that the hon. Member for Bradford West is proposing to include—although maybe not specifically. I would prefer it if we stuck with the list that the hon. Member for Spen Valley has put forward, and not add the additional witnesses proposed.
Lewis Atkinson
I agree with my hon. Friend the Member for Spen Valley. Having agreed to extend the time on Thursday to hear devolution issues and from the Royal College of General Practitioners and the Royal College of Psychiatrists, by adding two further witnesses, the amendment to the amendment would reduce the time available on those options. In an ideal world we would like to hear from all sorts of people. The option of written evidence is available. We have got other evidence, and I want to ensure that Thursday’s session is focused on the proposals that my hon. Friend has made.
Naz Shah
There is nothing in my amendment that suggests Professor Monckton-Smith is not capable in her expertise. I am asking for other expertise to be brought to the table. Yes, there is the argument that people can submit written evidence—but so could every witness we have heard from today, and that we will hear from tomorrow and the day after. If that is the yardstick, is this just a tokenistic exercise? I would argue that for women in particular, who are the victims of domestic abuse—
Dr Tidball
I note that Laura Hoyano, who is giving evidence on Thursday, is a domestic abuse barrister. She has also been involved in inquiries on child sexual abuse, and has a great range of experience in that area. She will bring that to the table as a practising barrister working closely on such cases.
Naz Shah
I welcome my hon. Friend’s intervention and I recognise Laura Hoyano’s expertise. I would respectfully push back that, as a victim of domestic violence—as a person who has experienced it and campaigned on it for all my adult life—there is a difference between an academic who has studied it and people who have worked with victims, in particular elderly women. The expert is a barrister with experience of young people and children and domestic abuse, and Professor Monckton-Smith is also an academic—yes, she has been a police officer—but I would value a witness who has worked with victims of domestic abuse. That is all I have to say on it.
Question put, That the amendment be made.
Question negatived.
Main Question put and agreed to.
Amendments made: (b), in the list of witnesses set out in the table in the Sittings Motion agreed by the Committee on 21 January 2025, after
“Professor Aneez Esmail (University of Manchester)”
insert “Disability Rights UK”.
Amendment (c), in the list of witnesses set out in the table in the Sittings Motion agreed by the Committee on 21 January 2025, after
“Dr Lewis Graham (University of Cambridge),”
leave out “John Kirkpatrick” and insert “Baroness Falkner”.
Amendment (d), in paragraph (2) of the sittings motion agreed by the Committee on 21 January 2025, after “Wednesdays” insert
“starting on 11 February 2025”.—(Kim Leadbeater.)
Ordered, That further consideration be now adjourned. —(Kit Malthouse.)
5.30 pm
Adjourned till Wednesday 29 January at twenty-five minutes past Nine o’clock.
Written evidence reported to the House
TIAB 01 Ben Scott
TIAB 02 Michael Vidal
TIAB 03 Compassion in Care
TIAB 03(a) Compassion in Care (further evidence)
TIAB 04 Dr George Gillett, an NHS doctor and psychiatrist
TIAB 05 Dr Stephen Hutchison MD
TIAB 06 Dr Andrew Boorne
TIAB 07 Jess Carrington, Registered Social Worker and Best Interests Assessor
TIAB 08 Greg Lawton MPharm MRPharmS FFRPS MBCS LLM, Barrister and Pharmacist
TIAB 09 Australian Care Alliance
TIAB 10 Dr Peter Knight
TIAB 11 Dr Isky Gordon FRCR, FRCP, Emeritus Professor Paediatric Imaging, UCL, London
TIAB 12 Dr Peter O’Halloran, RN, PhD, Registered Nurse, Senior Lecturer, Queen’s University Belfast, Researcher in chronic illness, palliative and end-of-life care
TIAB 13 Rose
TIAB 14 Dr Rachel Fisher
TIAB 15 Nigel Andrew Gordon Jones, a retired Consultant General Surgeon
TIAB 16 St Gemma’s Hospice
TIAB 17 Sir Nicholas Mostyn
TIAB 18 Leah Locke
TIAB 19 Alison Taylor
TIAB 20 Dr Katharine Crossland
TIAB 21 John Forrester
TIAB 22 Don Stickland
TIAB 23 Christina Blandford-Beards
TIAB 24 Society for the Protection of Unborn Children (SPUC)
TIAB 25 Catholic Bishops’ Conference of England and Wales
TIAB 26 British Association of Social Workers
TIAB 27 Plunkett Centre for Ethics: A centre of Australian Catholic University located at St Vincent’s Hospital Sydney
TIAB 28 Dame Sarah Mullally, Bishop of London, Lead Bishop on Health and Social Care for the Church of England and former Chief Nursing Officer for England on behalf of the Bishops of the Church of England and the Archbishops’ Council
TIAB 29 Cicely Saunders International
TIAB 30 Lejeune Clinic for Children with Down Syndrome
TIAB 31 Voice for Justice UK
TIAB 32 Get on Downs - a Down Syndrome Support Group
TIAB 33 British Medical Association (BMA)
TIAB 34 Portsmouth Down Syndrome Association
TIAB 35 Better Way campaign
TIAB 36 Hospice UK
TIAB 37 Association of Catholic Nurses for England and Wales
TIAB 38 East Midlands Palliative Medicine Consultants and Specialty Doctors
TIAB 39 Marie Curie Palliative Care Research Department, University College London (UCL)
TIAB 40 Humanists UK
TIAB 41 Nuffield Council on Bioethics’ (NCOB)
TIAB 42 Marie Curie
TIAB 43 LOROS, the Leicestershire and Rutland Hospice
TIAB 44 Professor Emeritus Sam H Ahmedzai
TIAB 45 Professor Nancy Preston, Professor of the International Observatory on End of Life Care, Lancaster University; and Professor Suzanne Ost, Law School, Lancaster University
TIAB 46 Professor Alex Ruck Keene KC (Hon)
TIAB 47 Anureg Deb and Dr Lewis Graham
TIAB 48 Australian Centre for Health Law Research, Queensland University of Technology, Australia
TIAB 49 The Bios Centre
TIAB 50 The Orders of St John Care Trust
TIAB 51 Living and Dying Well
TIAB 52 Professor Katherine Sleeman, King’s College London
TIAB 53 British Islamic Medical Association (BIMA)
TIAB 54 Joint written evidence submitted by Chelsea Roff (Eat Breathe Thrive, UK), Dr Angela Guarda (Johns Hopkins University School of Medicine, US), Dr Philip Mehler (University of Colorado School of Medicine, US), Dr Patricia Westmoreland (University of Colorado, US), Dr Scott Crow (University of Minnesota, US), Dr Catherine Cook-Cottone (University at Buffalo, SUNY, US), Dr Anita Federici (York University, Canada), and Dr Agnes Ayton (Oxford Health NHS Foundation Trust, UK)
TIAB 55 Professor Allan House
TIAB 56 National Care Forum (NCF)
TIAB 57 AtaLoss
TIAB 58 Compton Care
TIAB 59 Dr Odette Spruijt, Medical Director, Launceston Specialist Palliative Care Service
TIAB 60 Rachel Pegrum, Independent Social Worker
TIAB 61 Abdul Rahman Badran
TIAB 62 Alan Thomas, Professor of Old Age Psychiatry, Director of Brains for Dementia Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University
TIAB 63 Dr Julian Neal
TIAB 64 Dr Raymond Towey
TIAB 65 Multiple System Atrophy Trust
TIAB 66 Dr Adrian Tookman
TIAB 67 Royal College of Psychiatrists
TIAB 68 UK Medical Freedom Alliance
TIAB 69 Association of Anaesthetists
TIAB 70 Catholic Union of Great Britain
TIAB 71 My Death, My Decision
TIAB 72 Health Advisory and Recovery Team (HART)
TIAB 73 Kyam Maher MLC, the Attorney-General of South Australia, in his capacity as a member of the Legislative Council of South Australia
TIAB 74 Dr Calum MacKellar, Director of Research, Scottish Council on Human Bioethics
TIAB 75 Christian Medical Fellowship
TIAB 76 Christian Medical and Dental Association of Canada
TIAB 77 Christian Legal Centre
TIAB 78 Written evidence submitted on behalf of a group of anorexia nervosa sufferers and carers
TIAB 79 Dr Angelika Reichstein, Associate Professor in Law, University of East Anglia
TIAB 80 Dr David Randall
TIAB 81 Cruse Bereavement Support
TIAB 82 Compassion in Dying
TIAB 83 General Medical Council (GMC)
TIAB 84 Pathfinders Neuromuscular Alliance
TIAB 85 Royal Pharmaceutical Society
TIAB 86 Motor Neurone Disease Association
TIAB 87 Dr Simon Eyre
TIAB 88 Macdonald Amaran
TIAB 89 Patrick Pullicino
TIAB 90 Luis Espericueta, Researcher and lecturer in bioethics at the University of Granada, Spain
TIAB 91 Healthcare Professionals for Assisted Dying
TIAB 92 PSP Association (PSPA)
TIAB 93 Association for Palliative Medicine of Great Britain and Ireland (APM)
TIAB 94 Academy of Medical Royal College's
TIAB 95 Care Not Killing
TIAB 96 Dr Alexandra Mullock, Senior Lecturer in Law
TIAB 97 Rt Hon. Sir Stephen Sedley
TIAB 98 Carole O’Reilly
TIAB 99 Dr Hannah Denno
TIAB 100 Prof B Anthony Bell MD, Neurosurgeon, University of London
TIAB 101 Matthew Hoyle, Barrister
TIAB 102 Royal College of Nursing