Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting)
Tuesday 18th March 2025
(2 days, 11 hours ago)
Public Bill CommitteesTerminally 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 18 March 2025 - (18 Mar 2025)
The Chair
Will everyone ensure that all electronic devices are turned off or switched to silent? Tea and coffee are not allowed in the Committee Room.
We are continuing line-by-line consideration of the Bill. I remind Members that interventions should be short and raise points of clarification or questions; they should not be speeches in themselves. Members who wish to make a speech should bob and continue to do so through the whole debate in which they wish to speak, until they are called. When Members say “you”, they are referring to the Chair. “You” should not be used to refer to one another; the debate should be through the Chair.
Clause 13
Confirmation of request for assistance: second declaration
Amendment proposed (12 March): 457, in clause 13, page 9, line 17, after “made,” insert
“and have not voluntarily stopped eating and drinking”.—(Sarah Olney.)
Question again proposed, That the amendment be made.
The Chair
I remind the Committee that with this we are discussing the following:
Amendment 471, in clause 13, page 9, line 27, leave out from “if” to “that” in line 28 and insert
“the coordinating doctor is satisfied (immediately before witnessing it)”.
This amendment removes wording which would suggest that a second declaration is made before it is witnessed.
Amendment 316, in clause 13, page 9, line 36, at end insert—
“(5A) If, when making the statement under subsection (5), the definition of “second period of reflection” under subsection (2)(b) applies, the coordinating doctor must make refer the person for urgent specialist palliative care.”
This amendment will ensure that there is an immediate referral to a specialist in palliative care due if the patient is likely to die within a month of the declaration from the Court.
Amendment 374, in clause 13, page 10, line 2, at end insert—
“(8) Where the coordinating doctor has—
(a) witnessed a second declaration, or
(b) made or refused to make a statement under subsection (5),
the doctor must notify the Commissioner and give them a copy of the second declaration or (as the case may be) any statement under subsection (5).”
This amendment requires the coordinating doctor to notify the Commissioner of witnessing a second declaration, and of having made or refused to make a statement under clause 13(5).
Naz Shah (Bradford West) (Lab)
As we heard from the hon. Member for Richmond Park, her amendment concerns the second period for reflection under the Bill as drafted. The second period of reflection would take place after the panel had approved a person’s application for assisted death. The Bill states that that period would be 14 days, unless
“the coordinating doctor reasonably believes that the person’s death is likely to occur before the end of the period of one month beginning with the day that declaration was made”;
in that case, the second period is shortened to 48 hours.
Some people who have a strong desire to hasten death might wish to avoid the second period for reflection. If they refused food, there would be a strong possibility that their physical condition would deteriorate, so that a doctor would indeed believe that they were likely to die within one month. That is not a hypothetical possibility. We know that there are people who do refuse food to the point where they become gravely ill with malnutrition.
The right hon. Member for North West Hampshire said something that I think is relevant here. He was asking questions of a witness before this Committee, Professor Nicola Ranger of the Royal College of Nursing, on 28 January. To quote Hansard, the right hon. Gentleman said:
“At the moment, within palliative care and palliative nursing generally, you are already dealing with patients who are electing to refuse treatment, food and water, or are supporting patients following an advance directive.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 59, Q70.]
On the same day, the right hon. Gentleman said something similar to another witness, Dr Sarah Cox:
“I want to pursue that point a little with you, Dr Cox. My understanding is that your profession is already taking these decisions, or supporting patients to take these decisions—for example, the withdrawal of ventilation for an MND patient towards the end, or if I decide to decline treatment or food and water to end my life as quickly as I can.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 74, Q91.]
In other words, it is not some remote possibility that patients who are already ill may decide to refuse food. That is one thing I hope that the right hon. Gentleman and I can agree on. We also know from the survey undertaken by a group of specialists in eating disorders that, in countries that have assisted dying laws, at least 60 people have qualified for assisted death because they suffered advanced malnutrition.
Some people who are seriously ill and who wish, in the words of a psychiatric witness, to “hasten death”, may see the 14-day period as intolerable. An alarming possibility is that they might stop eating in order to worsen their physical condition and qualify for the 48-hour period. Amendment 457 would remove that possibility. I strongly recommend that hon. Members support it.
People would qualify for a shortened period for reflection only if they
“have not voluntarily stopped eating and drinking”.
That word “voluntarily” is important. I understand the reason that the Bill’s drafters included a provision for a shorter, second period of reflection, but as with much of the rest of the Bill, I am sorry to say that I do not think that they have provided strong enough safeguards. This is a well drafted amendment that would tighten those safeguards. I urge Members to support it.
Danny Kruger (East Wiltshire) (Con)
I will speak briefly to amendment 316 in the name of the hon. Member for York Central (Rachael Maskell). She has tabled a sensible suggestion that if a patient makes a statement after the second period of reflection, there should be an automatic referral to palliative care. We have heard how expected and usual that is anyway, and the hon. Member for Spen Valley has frequently made the point that people who are having an assisted death, or going through the process, are likely to be in palliative care anyway—it is not an either/or. It is important that we clarify that expectation.
It will obviously be the case that the patient is not required to take up the referral, and if the referral already exists, that case is dealt with, but let us be absolutely clear that the decision to take an assisted death is not a fork in the road, as would be my concern. If that is not the case and that, in fact, palliative care and the assisted death process go hand in hand and will be seen as part of an integrated package of support for patients, my view is that we should specify clearly that in the event of a decision to proceed down the road to an assisted death, a palliative care referral should be made.
Bluntly, I want to make this as clear as we can, although I am not sure that we will ever be able to do that fully. It really has to be very plain to healthcare commissioners and managers that there is to be no cost saving as a result of an assisted death referral. I very much doubt that a single commissioner or manager would have that at the forefront of their mind; nevertheless, incentives apply in healthcare decisions. Ultimately, we have a ration system, and resource allocation necessarily is the job of commissioners.
If, as we are saying, a decision to proceed with an assisted death will be in parallel with palliative care, let us make that plain, so that if indeed it is the case that the patient requires the investment of palliative care services—hospice treatment or otherwise, even though, as we know, hospice care is inadequately funded through public money—nevertheless, there is a resource requirement. It is important that we specify to everybody in the system that an assisted death is not a way of avoiding the expense of proper end-of-life care.
I hope that Members will recognise that amendment 316 is consistent with the arguments that have been made consistently by advocates of the Bill, which is that there is not an either/or between palliative care and assisted death, and that, in fact, it is appropriate for patients to be on both tracks simultaneously.
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairship, Ms McVey.
The purpose of amendment 457 is to exclude a person who has less than one month to live from being eligible for the shorter second period of reflection of 48 hours if that person has voluntarily stopped eating and drinking. That person would instead be required to comply with a second period of reflection of 14 days under clause 13(2)(a). The amendment could create uncertainty as to the required length of the period of reflection. It is unclear, for example, if “voluntarily” would include where someone’s appetite has naturally declined as they approach the end of life, and therefore whose decision to stop eating or drinking may not be deliberate.
As I have said previously, the Government have worked with my hon. Friend the Member for Spen Valley on certain amendments to bolster the legal and workability sides of the Bill, and the purpose of amendment 471 is to clarify that the co-ordinating doctor needs to be satisfied that, immediately before witnessing the second declaration, the criteria set out at subsection (4) are met, and not at any time before. That also ensures consistency with the duty on the co-ordinating doctor in respect of the first declaration.
Amendment 316 would require that where the co-ordinating doctor reasonably believes that the person seeking assistance has less than one month to live from the court declaration, they must refer that person for urgent specialist palliative care. As the referral must be made whether the patient wants that referral or not, this may result in unwanted referrals. The effect of this amendment is unclear.
As drafted, clause 13(2)(b) sets out that where the person’s death is likely to occur within one month, the period of reflection is then 48 hours. Amendment 316 sets out that the referral to urgent palliative care must be made alongside the co-ordinating doctor making the statement, which is the last step to be completed before the provision of assistance under clause 18. That would mean that in some circumstances, there may be insufficient time to make a referral before the person is provided with assistance to end their life.
Kit Malthouse (North West Hampshire) (Con)
I want to emphasise that at the moment the patient reaches that point, they will have had their palliative care options explained to them extensively, under the Bill, and it is highly unlikely at that point, as my hon. Friend the Member for East Wiltshire said, that anyone would not be in receipt of palliative care, given the very late stage of their disease.
Stephen Kinnock
I happened to be at a hospice in Stafford yesterday on a ministerial visit and was extremely impressed by the work that the hospice staff were doing on family counselling, and advice and engagement both with the patient and family and loved ones, so the right hon. Gentleman is right that the hospice sector, among others, plays a vital role in that holistic engagement with patients throughout the process.
Amendment 374 requires that the co-ordinating doctor must notify the voluntary assisted dying commissioner where they witness a second declaration and where they make or refuse to make the supporting statement under clause 13(5), and that the commissioner must be provided with a copy of the second declaration and any statement. I hope that those observations were helpful to the Committee.
Kim Leadbeater (Spen Valley) (Lab)
It is a pleasure to serve under you this morning, Ms McVey. My amendments 374 and 471 serve to clarify that the second declaration must be made before it is witnessed—it is a drafting amendment—and to bring clause 13 in line with the reporting requirements elsewhere in the Bill. For the functions of the commissioner to be carried out effectively, including supervising the assisted dying panels and making annual reports on the legislation’s operation, it is essential that all relevant details and reports are made available.
I am unable to support amendment 457, in the name of the hon. Member for Richmond Park. As I said when we started discussing the amendment, I do not fully understand why it has been positioned at this stage in the process. The shorter period of reflection is a recognition that a person’s death is expected within a month, so they literally have a few weeks left of life.
Sarah Olney (Richmond Park) (LD)
That was the hon. Member’s response when I made my speech on the amendment in the previous sitting. I have reflected on that over the weekend. I still think that the issue of the voluntary stopping of eating and drinking is a very serious one that ought to be reflected somewhere in the legislation, but she is correct that, at this particular point, we are talking about the second period of reflection already being at an end, so it cannot be hastened in any way by such a measure. Therefore, I will be withdrawing the amendment.
Kim Leadbeater
I appreciate that; that is helpful and I thank the hon. Member. As the Minister said, a person whose death is approaching may have stopped eating and drinking for a number of reasons. They may simply be too ill. They may be unable to digest food. It may be that they have lost their appetite, or that they will be even more ill if they eat and drink, so it would seem particularly cruel to intervene on that basis at that point, but I appreciate her comments.
Amendment 316 in the name of my hon. Friend the Member for York Central seeks to mandate the action a doctor must take if a patient is likely to die within one month. Like other amendments, it goes against the basic principles that underlie the Bill—that the wishes of the person seeking assistance should be respected. Surely that is even more important than ever as they face their final weeks. As the right hon. Member for North West Hampshire said, palliative care will have been discussed at length throughout the assisted dying process. It is also worth noting, as the hon. Member for East Wiltshire said, that evidence from other jurisdictions with similar laws—Australia and America—shows that between 80% and 90% of people who have gone through the assisted dying process are already receiving palliative care, so I am not minded to support the amendment.
Sarah Olney
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Amendments made: 207, in clause 13, page 9, line 20, leave out “Schedule 4” and insert
“regulations made by the Secretary of State”.
This amendment provides that the form of a second declaration is to be set out in regulations (rather than in Schedule 4).
Amendment 470, in clause 13, page 9, line 26, at end insert—
“(3A) Regulations under subsection (3)(a) must provide that a second declaration contains—
(a) the following information—
(i) the person’s full name and address;
(ii) the person’s NHS number;
(iii) contact details for the person’s GP practice;
(iv) specified information about the certificate of eligibility;
(b) the following further declarations by the person—
(i) a declaration that they have made a first declaration and have not cancelled it;
(ii) a declaration that they understand that they must make a second declaration in order for assistance to be provided under this Act;
(iii) a declaration that they are making the second declaration voluntarily and have not been coerced or pressured by any other person into making it;
(iv) a declaration that they understand that they may cancel the second declaration at any time.
In this subsection “specified” means specified in the regulations.”
This amendment provides that regulations about the form of a second declaration must make the provision mentioned in paragraphs (a) and (b).
Amendment 471, in clause 13, page 9, line 27, leave out from “if” to “that” in line 28 and insert
“the coordinating doctor is satisfied (immediately before witnessing it)”.
This amendment removes wording which would suggest that a second declaration is made before it is witnessed.
Amendment 208, in clause 13, page 9, line 38, leave out “Schedule 5” and insert
“regulations made by the Secretary of State”.
This amendment provides that the form of a statement by the coordinating doctor following the making of the second declaration is to be set out in regulations (rather than in Schedule 5).
Amendment 472, in clause 13, page 9, line 41, at end insert—
“(6A) Regulations under subsection (6)(a) must provide that a statement under subsection (5) contains—
(a) the following information—
(i) the person’s full name and address;
(ii) the person’s NHS number;
(iii) the coordinating doctor’s full name and work address;
(iv) specified information about the certificate of eligibility;
(b) the following declarations by the coordinating doctor (in addition to a declaration that they are satisfied of all of the matters mentioned in subsection (4)(a) to (d))—
(i) a declaration that they are satisfied that a certificate of eligibility has been granted in respect of the person;
(ii) a declaration that the second declaration was made after the end of the second period for reflection;
(iii) if the second declaration was made before the end of the period mentioned in subsection (2)(a), a declaration that they have the belief mentioned in subsection (2)(b);
(iv) a declaration that they are satisfied that neither the first declaration nor the second declaration has been cancelled.
In this subsection “specified” means specified in the regulations.”
This amendment provides that regulations about the form of a statement under subsection (5) must make the provision mentioned in paragraphs (a) and (b).
Amendment 374, in clause 13, page 10, line 2, at end insert—
“(8) Where the coordinating doctor has—
(a) witnessed a second declaration, or
(b) made or refused to make a statement under subsection (5),
the doctor must notify the Commissioner and give them a copy of the second declaration or (as the case may be) any statement under subsection (5).”—(Kim Leadbeater.)
This amendment requires the coordinating doctor to notify the Commissioner of witnessing a second declaration, and of having made or refused to make a statement under clause 13(5).
Clause 13, as amended, ordered to stand part of the Bill.
Clause 14
Cancellation of declarations
Kim Leadbeater
I beg to move amendment 375, in clause 14, page 10, line 9, at end insert—
“(1A) Where notice or an indication is given to the coordinating doctor under subsection (1)(a), the doctor must as soon as practicable notify the Commissioner of the cancellation.”
This amendment requires the coordinating doctor to notify the Commissioner of a cancellation of a first or second declaration.
The Chair
With this it will be convenient to discuss the following:
Amendment 376, in clause 14, page 10, line 12, after “doctor” insert “and the Commissioner”.
This amendment requires a practitioner other than the coordinating doctor to notify the Commissioner (as well as the coordinating doctor) of a cancellation of a first or second declaration.
Clause stand part.
Kim Leadbeater
I hope that these are a couple of nice, simple amendments. The right of the patient to cancel at any time is obviously really important. It is also important that, for the purpose of monitoring and reporting the process, the commissioner, as proposed, is kept informed at every stage. I hope that the whole Committee can see the necessity of these amendments.
Danny Kruger
The hon. Lady is quite right that there is nothing to object to in these amendments or the clause. It is worth stating at this point, though, that in the context of the debate we are having in this Committee, we are moving at some pace. The likelihood is that there will be opportunity for only a five-hour debate on Report—maybe more, but possibly not. This Committee is the time we have to consider in detail the content of the Bill. My concern is that moving too quickly and trying to do too much too soon means that we will miss the opportunity to debate very important aspects of the Bill.
The hon. Lady says that these are “nice, simple” amendments, as if the only thing being discussed here is the paperwork around the declaration. What should we say to patients who decide to cancel their declaration? My concern—I am unaware of any other point when we could appropriately discuss this question—is what happens in the event of a cancellation. What duty of care do doctors have to patients who have decided not to proceed with an assisted death? The Bill does not currently address that question: it imposes no obligation on doctors to follow up in any way after a declaration has been cancelled.
Danny Kruger
Before I give way to my right hon. Friend, I want to posit the hypothesis of a private provider that has been established explicitly for the purpose of facilitating the assisted death procedure for patients. If that provider steps back when the patient decides to cancel their declaration, the provider is required to notify the GP as soon as practicable, whatever that means—the timeframe there is clearly at the convenience of the provider, not the patient. My concern is what happens when the patient’s GP is not quickly informed that they have decided not to proceed with the assisted death and they are sitting in limbo. Obviously, there are significant concerns about their wellbeing, given their decision and the state they are in. It is not yet fully clear to me what the obligations on the doctors would be at that stage.
Kit Malthouse
I am not entirely certain that my hon. Friend’s remarks are germane to the amendments, but nevertheless. As we discussed when debating clause 13, at the stage he is talking about, the patient will have had all their options—“all appropriate”, as I think we have amended the Bill to say, services that will be available to them—explained to them. If they are cancelling, the presumption has to be, in respecting their autonomy, that they are choosing one of the alternative paths that has been laid out to them. It is quite hard to legislate for a negative.
Danny Kruger
I am speaking to the group as a whole, which includes clause stand part. I have no objection to the amendments. My right hon. Friend is absolutely right. As I said, the expectation is that the medical professionals involved in the person’s care will have laid out their options clearly. We are to a certain degree trusting in that because amendments to insist on it have been rejected, although I recognise that it will be the clear expectation. He is right that it is hard, as it were, to prove a negative.
Nevertheless, the purpose of my speech at this point is to tease out from the advocates of the Bill what their expectation is. My right hon. Friend has clearly explained his expectation, which is that we are dealing with somebody whose mind is clear, rational, uncluttered by other concerns and entirely free of any undue influences or anxieties about the different choices they might make. Having previously decided in the fullness of their autonomy that they wanted to go through the procedure, they have now decided in the fullness of their autonomy that they want to do the opposite, and we should say, “Fine. We have no further interest in your decision making. It is your choice—you’re on your own.” I am very concerned about the implication of my right hon. Friend’s comments about the sorts of patients who might be involved in the process of assisted dying.
Kim Leadbeater
To allay those fears, perhaps the fundamental answer to the question is that those people do not stop being patients—sadly, they do not stop being terminally ill patients. They have just chosen to cancel the declaration, and they will already have wraparound care. To some degree, the hon. Gentleman answered his own question when he said that doctors have a duty of care. That duty of care does not stop because the person has chosen to take this course of action. They will still be cared for by the professionals looking after them.
Danny Kruger
Well, we certainly hope so. Nevertheless, that is inconsistent with the doctrine of absolute patient autonomy, which in this circumstance allows a patient to withdraw from the medical treatment, or at least from the support of the medics who had been facilitating their assisted death. They are rightly under no obligation to receive any other sort of care.
Of course, one would assume that in most cases medics will be closely involved in looking after these patients, because they are likely to be very ill. Nevertheless, the Bill has nothing more to say about patients who have just stepped back from the brink of suicide; the medics will have no further obligation to ensure that they will be looked after—except by the GP, as soon as it is practicable for the provider who has just been denied the business of looking after the assisted death to get round to emailing them. If that is seen as sufficient to ensure that those patients will be properly looked after, I beg to differ.
Kit Malthouse
I am not sure what compulsion there is in wider legislation for there to be a duty of care to patients who do not choose assisted dying in the first place. For thousands and thousands of patients who die, there is no legislation that imposes certain duties on medics or others to look after them; we rely on the professional standards and overall atmosphere of the healthcare system, as we would in the case of these patients.
As my hon. Friend knows, overseas experience shows that a large proportion of the people who obtain the right to an assisted death—up to a third—do not cancel but do not exercise it. As we have said before, for many people assisted dying is an insurance card that they may choose to use if and when they think their life becomes intolerable.
Danny Kruger
I recognise that, but that is not germane to the debate that we are having, which is about the actual cancellation. There is a question about why there would have been a cancellation. My right hon. Friend is right that there is no obligation to proceed once a patient passes a particular hurdle. Many will not, but when someone decides actively to renounce their decision, a big question should be asked: what is going on, and what further help is needed?
My right hon. Friend suggests that we do not step in and ensure that care is provided—that, in other circumstances, there is no additional obligation in relation to patients. I am afraid to say that he has, as ever, a coldly rationalistic vision of healthcare and of the sorts of patients we are dealing with. As I have said to him, these patients will be acting much as I imagine he would imagine—I think from a position of health and self-confidence—himself acting in that circumstance. In fact, we are dealing with people who have decided to renounce their decision to proceed, and so are by definition in some turmoil.
I crave the indulgence of the Committee, because I am talking at length about a set of amendments that I do not intend to oppose, and I recognise the value and necessity of the clause. However, I draw to the Committee’s attention that we are dealing not simply with a bit of paperwork, but with a human being who, having made one enormous decision—to die—is now making an enormous decision to live, and we are treating it as if it is only a bureaucratic question.
I finish with a question to the hon. Member for Spen Valley or to the Minister, to help me understand something that confuses me in the clause.
Naz Shah
I have not given this matter as much thought as the hon. Member has. My interest is very much in the issue of domestic violence. Does he agree that this could be somebody who has experienced domestic violence? Or children could be at risk. This person may then decide not to take the option, even though they wanted to, because of obligations elsewhere.
Danny Kruger
The hon. Lady is right, and her point goes to the question that runs through all of these clauses: why? As a Committee, we rejected the obligation on the doctors to ask, “Why are you doing this?” It was suggested by one hon. Member that it was nobody’s business why somebody was trying to take their own life and that if that person qualified, they should be able to summon the agents of the state to provide them with lethal drugs without any question about their motivation.
I agree with the hon. Lady. There is an equal expectation in my mind that doctors should ask the question, “Why are you changing your mind?” I would expect that. The clause could clarify what further referrals would need to be made, if they had not already been; as we have acknowledged, we would expect appropriate care to be provided by doctors anyway.
I conclude with a factual question. Clause 14(1) lets a patient cancel a first or second declaration, but subsection (4) says only that the duties of the doctor stop when a first declaration is cancelled. I would be grateful if the hon. Member for Spen Valley would explain what happens if the patient cancels a second declaration. It strikes me that there would be a need for urgency because if a patient decides to change their mind at that point, that is arguably a more dangerous situation. What would be the obligations on the doctor at that point? Should we read across from subsection (4) that their duties stop in the same way? Perhaps that could be clarified in later drafting, if necessary.
To conclude, my general point is that the issue of a cancelled declaration is about more than the paperwork. Although, of course, we respect the autonomy of a patient to make their own decision to cancel a declaration—obviously, I would insist that that right should be in the Bill—it nevertheless raises a question in my mind: why is that happening, and what should we expect the patient’s medical team, or others, to do in that circumstance?
Stephen Kinnock
The Government have worked with my hon. Friend the Member for Spen Valley on amendments 375 and 376. The amendments require that where the co-ordinating doctor, or any registered practitioner from the person’s GP practice, receives a notification or indication from the person seeking assistance under the Bill that the person wishes to cancel their first or second declaration, the doctor or practitioner must inform the voluntary assisted dying commissioner as soon as practicable. Where a registered practitioner from the person’s GP practice has received a notification or indication from the person to cancel their first or second declaration, they must also inform the co-ordinating doctor. I hope those observations are helpful to the Committee.
Kim Leadbeater
I repeat what I said earlier about what will happen to the patient if they choose to cancel: their care will continue. From a medical practitioner perspective, it is inconceivable that those patients would be abandoned, as the hon. Member for East Wiltshire is suggesting. That would not happen.
I understand that cancellation of the second declaration does not need to be included in clause 14(4) because of when in the process it would happen. The first declaration comes much earlier, so clauses 7 to 9 would be applicable; the second declaration comes further down the process, so does not need to be included. However, I am happy to look at that in further detail and come back to the hon. Member on that, if necessary.
Amendment 375 agreed to.
Amendment made: 376, in clause 14, page 10, line 12, after “doctor” insert “and the Commissioner”.—(Kim Leadbeater.)
This amendment requires a practitioner other than the coordinating doctor to notify the Commissioner (as well as the coordinating doctor) of a cancellation of a first or second declaration.
Clause 14, as amended, ordered to stand part of the Bill.
Clause 15
Signing by proxy
Daniel Francis (Bexleyheath and Crayford) (Lab)
I beg to move amendment 321, in clause 15, page 10, line 33, at end insert—
“(d) the reason why the person was unable to sign their name.”
The Chair
With this it will be convenient to discuss the following:
Amendment 431, in clause 15, page 11, line 1, leave out paragraphs (a) and (b) and insert
“the donee of Lasting Power of Attorney for Health and Welfare decisions, who has the ability to give or refuse consent to life-sustaining treatment, as registered with the Office of the Public Guardian.”
This amendment would restrict proxies to donees of Lasting Power of Attorney for Health and Welfare decisions, including to give or refuse consent to life-sustaining treatment.
Amendment 473, in clause 15, page 11, line 3, leave out from “person” to end of line and insert
“of a description specified in regulations made by the Secretary of State.”
This amendment provides that persons of a description specified in regulations (rather than persons “of good standing in the community”) may be proxies.
Amendment 253, in clause 15, page 11, line 3, at end insert—
“(6) For the purposes of this section “declaration” includes the cancellation of a declaration.”
This would allow a cancellation of the first or second declaration to be signed by a proxy.
Clause stand part.
Daniel Francis
It is a pleasure to serve under your chairship, Ms McVey. Amendment 321 will mean that the proxy’s declaration must also include the reason why the person was unable to sign their name. That would add a vital safeguard for the person and for the proxy.
In this Committee, we have consistently discussed the need to safeguard vulnerable people from being coerced into choosing assisted dying; for those who need a proxy, the risk of coercion might be higher. As the Bill currently stands, the person needs to tell only their proxy the reason why they are needed. I would like to make it clear why the amendment is important. The Bill does not currently specify that the patient’s declaration of the reason for needing a proxy has to be heard by anyone other than the proxy themselves.
I am conscious that, since my amendment was tabled, my hon. Friend the Member for Spen Valley has also tabled amendments about the relationship and who the proxy could be, but I do not believe that amendment 321 would be a burden or cause any unnecessary complication. As the Bill currently stands, when a proxy signs the declaration they already have to include their full name and address, the capacity in which they qualify, and a statement that they have signed in the capacity of a proxy.
As we have said before, it is vital to safeguard vulnerable people at every stage of the process; adding the reason why the proxy was required allows other people during the process, including if there were allegations later, to understand why that was required. If the first declaration is signed by a proxy, then the co-ordinating doctor—the independent doctor—would be able to examine that reason, so including the reason for someone being unable to sign their own declaration would improve transparency around the process. I hope that hon. Members will agree that we need to be able to monitor how those requests are made and the reasons that people are giving.
In written evidence, several experts raised the importance of collecting good data to ensure that the assisted dying process is properly monitored, and amendment 321 would assist that; I believe that it would protect both vulnerable patients and proxies. I absolutely appreciate and understand that people may have a very good reason for requiring a proxy—if they are very ill during the process, for example. The amendment would simply mean that, if there were to be concerns or allegations at a later stage, the reason why the proxy was required would be written down.
Kim Leadbeater
My hon. Friend is making a really sensible point and a fair argument, and I am very happy to support the amendment.
Daniel Francis
I welcome my hon. Friend’s acceptance of the amendment, and I think she sees the point behind it. It was meant not to be awkward—I do not think I have been at all awkward during this process—but simply to state that, if there were concerns later, the reason why the proxy was required should be there in a transparent way. I commend amendment 321 to the Committee.
Danny Kruger
I am grateful to the hon. Gentleman and I very much support his amendment; it is good to hear that the Bill’s promoter, the hon. Member for Spen Valley, will as well. The hon. Member for Bexleyheath and Crayford has made his points very powerfully, and it is good that we are in agreement.
I also support amendment 431, tabled by the hon. Member for York Central, which would restrict proxies to donees of lasting power of attorney. The point is that somebody who has been through the process of taking on power of attorney has been properly vetted and approved; they are required to demonstrate their fitness for the role and undertake a meaningful duty of care to the person for whom they are a proxy. That strikes me as an appropriate suggestion from the hon. Lady.
Amendment 411, tabled by the hon. Member for Broxtowe, suggests that the phrase
“a person who is of good standing in the community”
should be deleted. I think she is absolutely right to suggest that. I made the point on Second Reading that—
Danny Kruger
I think the hon. Lady is about to say that her own amendment addresses that point.
Danny Kruger
Okay. I am grateful to the hon. Member for Spen Valley, if so. I regret it, because I think amendment 411 had a good suggestion. It would have been my preference if we were just amending the provision, although removing the whole question of a proxy might be the safest thing. Nevertheless, if we are proceeding with the proxy arrangement, it strikes me as dangerous to include a person of good standing in the community. While it sounds like an old-fashioned and sonorous expression, as if it has genuine meaning and recognition, I do not think it is an acknowledged concept and does not appear in English law much, if at all. It obviously begs the question of what on earth it means, and who is to determine who is of good standing.
I labour the point even though the amendment might have been withdrawn, because amendment 473 in the name of the hon. Member for Spen Valley proposes to delete that phrase and give the responsibility for who the proxies could be to the Secretary of State. That is another important instance of a running flaw in the Bill, and particularly the amendments tabled in Committee, which is the transferring of important decisions beyond the Committee and Parliament to the Government and the Minister of the day.
That matters, because we are trying to ensure that when the Bill passes—if it passes—it is safe, but a blank space is being left on the important question of who can determine who the proxies are. The proxies have enormous power to do the paperwork and to answer the questions—to essentially act on behalf of the patient who, in the scenario envisaged, would be silent. It matters who the proxy is.
The decision of the hon. Member for Spen Valley is not to resolve that question here in Committee but to pass it on to a future Minister. My concern is that the same ambiguity or openness that is currently in the Bill about this person of good standing—a serious-sounding but actually vacuous concept—could be replicated in the regulations specified by the Secretary of State.
I am worried about where we are going here. Instead, I wish that we could restrict the proxy to somebody known to the patient, without the inclusion of the person of good standing or, if we are to do without that phrase and imagine that there will be other criteria and other individuals judged appropriate to be the proxy, that we had the will to determine that now. The hon. Member for Spen Valley, working with the Government, may well have concluded that they did not have enough time to come up with such a list or to think through the various complications involved in deciding who the proxy should be. Again, if that was the case, I regret the pace at which we are moving. I do not see why the decision has to be delayed until the Secretary of State comes up with a plan in a couple of years’ time and why it is not being resolved in the Bill now.
The Chair
I confirm that amendment 411 has been withdrawn. I see no other Members bobbing; I call the Minister.
Stephen Kinnock
Amendment 321 would require a proxy to record, when signing the declaration on behalf of the person, the reason why the person they are acting as a proxy for is unable to sign their own name. The recording of the reason may make the use of a proxy more transparent. It may also assist others involved in the scrutiny of the process to understand why a proxy was used.
Amendment 431 seeks to restrict who can be a proxy under the Bill to attorneys with a lasting power of attorney, or LPA, for health and welfare decisions—that is, those people who are able to consent to or refuse life-sustaining treatment. The amendment raises significant practical issues. First, not everyone has an LPA. Secondly, where a person has made an LPA, they will have decided whether to give the attorney the authority to refuse or consent to life-sustaining treatment. That is not automatic and means that not all attorneys would be able to meet the eligibility requirement of the amendment. Thirdly, the Mental Capacity Act 2005 enables an attorney to exercise power under an LPA only if and when someone has lost capacity.
Kit Malthouse
Does the Minister agree that, unfortunately, my hon. Friend the Member for East Wiltshire seems to be labouring under the misapprehension that there is some reputational test in becoming an attorney? In truth, I can appoint anybody I want to be my attorney. There is no verification or otherwise until there is some form of dispute around the exercise of the power of attorney. In fact, the regulations may mean that we have stronger verification of the bona fides of the person who is a proxy than we would have through the LPA route.
Does the Minister not also find it slightly sad that, given the type of Conservative I know my hon. Friend the Member for East Wiltshire is, he thinks the concept of being of good standing in society is somehow meaningless?
Stephen Kinnock
I am not a lawyer, but thankfully I am sitting next to a very eminent and distinguished one—my hon. and learned Friend the Member for Finchley and Golders Green—who has confirmed that everything the hon. Member for East Wiltshire said was correct from a legal standpoint, so I shall leave it at that.
Clause 15(5) of the Bill defines a proxy as
“(a) a person who has known the person making the declaration personally for at least 2 years, or
(b) a person who is of good standing in the community.”
Amendment 473 would remove subsection (b) from the definition of proxy, instead introducing a regulation-making power to specify the persons who may act as proxy. That would avoid any ambiguity around the meaning of a person who is of good standing in the community and retain flexibility to amend the specified list in regulations.
Danny Kruger
Will the Minister confirm that the Secretary of State could simply reintroduce that ambiguous term at their own discretion? If they are being given the freedom to decide who can be a proxy, they might decide that it should be a term of equal ambiguity. My right hon. Friend the Member for North West Hampshire is absolutely right that I have great respect for the concept of “standing”; nevertheless, I do not believe that the Government have yet been able to define exactly what that means. Does the Minister agree that there is still the opportunity for ambiguity? We are just leaving it completely blank at this stage and hoping that some future Secretary of State will have more clarity than we do.
Stephen Kinnock
I would not want to pre-empt the regulations, because clearly that is the point of the process. If this Bill gets Royal Assent, we then move on to making regulations, and I have confidence in the good offices of parliamentary counsel, legal advice and the drafting process. I absolutely agree with the hon. Gentleman, however, that the purpose of those regulations must be to remove ambiguity, not to increase it. I am confident that the system will produce regulations that address his concern.
Kim Leadbeater
Does the Minister agree that it will be on the record that we have had this conversation, and that many of us—including myself—have expressed our concerns about the concept of good standing in the community? I would like to think that that will be taken into consideration.
Stephen Kinnock
I am acutely conscious that every word we say in this Committee is on the record. My hon. Friend makes a valid point in that context.
The purpose of amendment 253 is to clarify that a person acting as a proxy can both sign and revoke a declaration on behalf of a person seeking assistance under the Bill. This amendment would extend the provisions under clause 15 to a person who is acting as proxy to the person seeking assistance under the Bill, enabling the proxy to act on behalf of the person to cancel their first or second declaration if they are unable to sign their own name by reason of physical impairment, being unable to read or for any other reason. I note that the cancellation of a declaration is governed by clause 14, and the cancellation may be given orally, via writing, or
“in a manner of communication known to be used by the person”.
It does not require the signature of the person seeking assistance under the Bill, so a proxy may not be required for some people in relation to revoking a declaration, even if they have been required under clause 15.
Naz Shah
On the point made by the Bill’s promoter, my hon. Friend the Member for Spen Valley, should the issue of proxy end up before a court, what will be relied on—the conversation that we are having here and the intentions stated in Committee, or a future statutory instrument and what the Secretary of State puts in the guidance?
Stephen Kinnock
The regulations will have primacy, and will be shaped by a range of inputs, including the conversation we have just had in Committee. The process is that the Bill gets Royal Assent, then the regulations are drawn up based on a range of consultations and inputs—including the Hansard. The regulations then become the basis on which this proxy process is managed, enforced and executed.
Stephen Kinnock
The Bill, once it becomes an Act, places a legal duty on the Secretary of State to produce those regulations. The Secretary of State would be in breach of the law if he were not to enforce the conclusions of the Act.
Kim Leadbeater
I will speak first to my amendment 473. It is important to be clear that the role of the proxy is very specific and would be used only in a very limited number of cases, where the patient is not able to sign their own name. That is, however, important when we are talking about terminally ill people who may be physically impaired, as my hon. Friend the Member for Bexleyheath and Crayford alluded to.
Danny Kruger
I am sorry to interrupt the hon. Lady so soon into her speech. Nevertheless, the clause says that someone can use a proxy when they are unable to sign their name
“by reason of physical impairment, being unable to read or for any other reason”.
Does the hon. Lady acknowledge that that is tantamount to saying that somebody can have a proxy for any reason at all? There is literally no restriction in the clause on the reason for why somebody could have a proxy—anybody could have one.
Kim Leadbeater
That is why amendment 321 in the name of my hon. Friend the Member for Bexleyheath and Crayford is really important. We have to put the reason down for why there is a proxy. It depends on personal circumstances and what that patient is going through, so we have to have a bit of flexibility, but they have to be unable to sign their name and they have to explain why they are unable to sign their name.
Danny Kruger
I hope that this does not appear pedantic, but we are talking about life and death after all. The patient’s inability to sign their name could be psychological; it is not as if they will have to do a writing test. They simply have to say that they are unable to sign their name, unless the hon. Lady is proposing that there could be some sort of test for that.
I entirely support amendment 321 in the name of the hon. Member for Bexleyheath and Crayford about the proxy being obliged to state the reason why—it is good to finally have the question “Why?” being asked in the Bill. Nevertheless, there is no obligation for anything to be done about that reason; someone could give a reason that would be regarded as irrelevant. I respect the intention behind the amendment, but it does not clarify the point that literally anybody could effectively get a proxy to sign their name, having said to the assessing doctor, “I want my friend to sign for me.”
Kim Leadbeater
That is the sort of thing that the doctor would explore with the patient. It would happen in a very limited set of circumstances. We have to accommodate people who are physically impaired as a result of their terminal illness, and we have to include that there are a range of circumstances where this might apply. The proxy is being asked not to make any kind of judgment or assessment, but merely to act as an intermediary for the patient if they are unable to sign for themselves. They would have to explain why they are unable to sign for themselves, and the proxy has to be satisfied that the person understands the nature and effect of the making of the declaration.
I thought long and hard about who should and should not be accepted as a proxy. As always, I try to imagine how it would be seen by someone with a terminal illness. As we know, no two people are the same, nor are their circumstances. The hon. Member for East Wiltshire said that surely it should be done by someone the patient knows. The clause defines a proxy as someone the patient has known for two years, which is an important inclusion, but not everyone might have known for two years a person who they are comfortable asking to undertake that role.
I also appreciate the challenges with the wording
“of good standing in the community”.
I will let the hon. Member for East Wiltshire and the right hon. Member for North West Hampshire fight that out among themselves. I am sure we all have our own version of what that means.
I have explored various options and, contrary to the suggestion of the hon. Member for East Wiltshire, I have spent a huge amount of time on this question, because it is very important. Looking at different lists, there is the list of people who can sign the back of someone’s passport. I do not think that would be appropriate, so I moved away from that. I have also looked at much shorter lists. I do think that this question would be part of a consultation; it is really important to get it right, which is why we must have it as part of a consultation. I am content that having the Secretary of State put it in regulations is the right thing to do.
As I said, I am happy to support amendment 321 in the name of my hon. Friend the Member for Bexleyheath and Crayford. It is a sensible amendment that makes the reasons for the use of the proxy more transparent. If amendment 253 in the name of my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove) is moved, I am happy to support that too. As the Minister said, a cancellation need not be in writing; it can be made orally or through any other form of communication.
Amendment 321 agreed to.
Amendment made: 473, in clause 15, page 11, line 3, leave out from “person” to end of line and insert
“of a description specified in regulations made by the Secretary of State.”—(Kim Leadbeater.)
This amendment provides that persons of a description specified in regulations (rather than persons “of good standing in the community”) may be proxies.
Amendment made: 253, in clause 15, page 11, line 3, at end insert—
“(6) For the purposes of this section “declaration” includes the cancellation of a declaration.”—(Sean Woodcock.)
This would allow a cancellation of the first or second declaration to be signed by a proxy.
Clause 15, as amended, ordered to stand part of the Bill.
Clause 16
Recording of declarations and statements etc
Amendments made: 209, in clause 16, page 11, line 8, leave out paragraphs (b) and (c) and insert—
“(b) a report about the first assessment of a person is made under section 7;
(c) a report about the second assessment of a person is made under section 8;”.
This amendment is consequential on Amendments 420 and 421.
Amendment 377, in clause 16, page 11, line 12, leave out paragraph (d) and insert—
“(d) a certificate of eligibility has been granted in respect of a person;
(da) a panel has refused to grant such a certificate;”.—(Kim Leadbeater.)
This amendment is consequential on NC21.
Kim Leadbeater
I beg to move amendment 474, in clause 16, page 11, line 17, at end insert—
“(1A) In this section ‘recordable event’ means an event mentioned in a paragraph of subsection (1).”
This amendment is consequential on amendments 209 and 377.
The Chair
With this it will be convenient to discuss the following:
Amendment 475, in clause 16, page 11, line 19, leave out from second “the” to “in” in line 21 and insert
“occurrence of the recordable event”.
This amendment is consequential on amendments 209 and 377.
Amendment 476, in clause 16, page 11, line 24, leave out from “the” to “, and” in line 26 and insert
“occurrence of the recordable event”.
This amendment is consequential on amendments 209 and 377.
Amendment 477, in clause 16, page 11, line 27, leave out from “the” to “in” in line 29 and insert
“occurrence of the recordable event”.
This amendment is consequential on amendments 209 and 377.
Amendment 478, in clause 16, page 11, line 30, leave out from second “a” to end of line 32 and insert
“declaration, report or statement within subsection (1) must include the original declaration, report or statement.”
This amendment is consequential on amendments 209 and 377.
Clause stand part.
Kim Leadbeater
The amendments are designed to streamline the drafting of the Bill. Taken together, they create a new definition of a recordable event, namely those events set out in clause 16(1), where declarations and statements are required at any stage of the process. We can all agree that record keeping is essential, so it is necessary to define the events that should be recorded. I commend the amendments to the Committee.
Danny Kruger
I very much respect the hon. Lady’s intention, and I support the amendments. On clause 16, however, I must take the opportunity to express a certain concern. The clause applies if, under subsection (1)(b), the co-ordinating doctor
“refuses to make…a statement”
to be entered into the person’s medical records. That is good but, as I understand it, a statement could be made that complies with the Bill but does not put on record, in relation to subsection (2), which requirements the co-ordinating doctor did not believe were satisfied. We have missed an opportunity to have more clarity about which exact requirements have not been met. There is also the eternal question about the co-ordinating doctor’s reasons for reaching that conclusion. I just note the missed opportunity to be a little safer with the drafting.
My more general point is about the importance of effective record keeping and declaration. I thank the hon. Member for Spen Valley, who throughout the whole Bill process has stressed the importance of good data collection and record keeping, which will be vital so that in later years, if the Bill passes, we can judge whether it is working as intended.
I am concerned about going on the evidence of other countries, which is frequently adduced in support of the Bill, particularly in respect of the absence of evidence of coercion, questions around capacity, proper administration of drugs or the support that patients receive. It is often said that concerns are exaggerated or inappropriate, “because look at what happens in other countries”, but let me briefly run through some evidence from abroad.
The fact is that no other country does adequate record keeping. One ambition of the hon. Member for Spen Valley that I really do share is to have a better system of keeping data than in other countries. In Oregon, the most recent annual report demonstrates a whole series of failures in record keeping. Ingestion status was unknown for 25% of the patients prescribed the drugs, so we do not know whether they took the drugs or what the process was. In 72% of cases, it was unknown whether there were complications; we have been talking about how exaggerated my concerns and those of other Members are about complications, but in 72% of cases in Oregon we do not know. In 30% of cases, it was unknown whether a healthcare provider was present. In 44% of cases, the duration between ingestion and death was unknown.
I very much recognise that the intention of the Bill is not to have those sorts of mistake. Indeed, the intention is to ensure that some of them should be impossible, because a doctor should be present and so on. Nevertheless, there is evidence that in other countries that have inspired the Bill, the data is inadequate. I will give a few more examples.
British Columbia has poor documentation, incomplete assessments, recurrent and excessive delays in reporting. In the debate on the last group of amendments, we spoke about the necessity that a doctor be informed if a declaration is cancelled; I am very concerned that that will not happen quickly and that people could fall through the gaps. That is what happens abroad. We have seen evidence from the former Attorney-General of Victoria, Australia, of all sorts of irregularities, with doctors falsely certifying that patients had signed statements and so on.
Kim Leadbeater
I do not know the details of the individual cases that the hon. Member speaks about, but he makes a powerful point and we absolutely agree on the importance of recording and monitoring. I know that he voted against the changes at clause 12, but I hope he gets some reassurance from the changes that the commission would bring in. Having the commission and the panels would ensure robust monitoring and reporting. I hope he agrees that that is a positive step.
Danny Kruger
I absolutely recognise that the hon. Lady has every intention of insisting that the system works well, that doctors do their job and that good record keeping happens. My concern throughout has been that we have not been robust enough in ensuring that all of that happens.
A huge amount of faith is being placed in the good professional conduct of doctors. Patient autonomy has been stressed, but it often translates into doctor autonomy. We are relying enormously on doctors doing their job well, and we are giving them significant latitude to do their job properly. As we see in other jurisdictions, particularly when assisted suicide becomes normalised and services are established explicitly to provide assisted suicide, we get into a dangerous area in which adequate documentation and reporting might not happen.
I will conclude with evidence from Canada, which is a very comparable country; it has a slightly different mechanism for delivering assisted suicide, but its legal framework is very similar to ours. The Health and Social Care Committee in our last Parliament received evidence from an academic in Canada, Dr Kotalik, who stated that federal regulations had been
“mandating a collection of data from MAID providers”,
just as the Bill will do. However, he noted that
“those legal and regulatory efforts have yet to produce evidence that the program operates as intended. We have no publicly accessible evidence that the eligibility criteria and safeguards prescribed by law were respected and that the Criminal Code has not been transgressed.”
It is fine for us, in this Committee and in Parliament, to specify that all doctors should do their job properly and that all data should be appropriately collected, transmitted and recorded. Nevertheless, as we all know from our casework, the reality is often one of bureaucratic mistakes being made, albeit not with any ill will. Given the volumes that we may well be dealing with, I think it is appropriate to raise significant concerns about the operation of the Bill and the data collection that we seek.
Sojan Joseph (Ashford) (Lab)
Record keeping is a huge issue in our healthcare system. A huge number of coroners’ reviews have identified that record keeping has been an issue. By specifying only that clinicians need record a “recordable event”, we are leaving it as the responsibility of individual clinicians to decide what a recordable event is.
It is important that a good record be available to prevent future incidents and learn good practice. Leaving it open to a clinician to decide whether something is a recordable event could lead to most issues not getting recorded. For example, if a clinician has identified that there was coercion, it will be for the clinician to decide how much documentation to do. In my view, if they have identified a coercion, that should be recorded as an incident and further investigation should be done, but the Bill leaves it up to the clinician to decide. There is no standard for record keeping across the healthcare system, so a care home’s may be different from an NHS ward’s. I think it is for the Committee to look into what “recordable event” actually means.
Stephen Kinnock
The purpose of amendments 474 to 478 is to improve the drafting of the Bill by creating a new definition of “recordable event”. Recordable events are the events set out in clause 16(1) related to the recording of declarations and statements.
The amendments would also make consequential changes to clause 16, which refer to the occurrence of the recordable event, as per the new definition, and include reference to a report in addition to a statement or declaration. The reference to a report is consequential on the amendments already agreed by the Committee to clauses 7 and 8.
Kim Leadbeater
I have nothing further to add.
Amendment 474 agreed to.
Amendments made: 475, clause 16, page 11, line 19, leave out from second “the” to “in” in line 21 and insert
“occurrence of the recordable event”.
This amendment is consequential on amendments 209 and 377.
Amendment 476, in clause 16, page 11, line 24, leave out from “the” to “, and” in line 26 and insert
“occurrence of the recordable event”.
This amendment is consequential on amendments 209 and 377.
Amendment 477, in clause 16, page 11, line 27, leave out from “the” to “in” in line 29 and insert
“occurrence of the recordable event”.
This amendment is consequential on amendments 209 and 377.
Amendment 478, in clause 16, page 11, line 30, leave out from second “a” to end of line 32 and insert
“declaration, report or statement within subsection (1) must include the original declaration, report or statement.”—(Kim Leadbeater.)
This amendment is consequential on amendments 209 and 377.
Clause 16, as amended, ordered to stand part of the Bill.
Clause 17
Recording of cancellations
Kim Leadbeater
I beg to move amendment 479, in clause 17, page 11, line 37, leave out “at” and insert “with”.
This amendment clarifies that a cancellation may be given to a practitioner with the person’s GP practice.
Kim Leadbeater
The amendment, which would clarify the drafting, speaks for itself. The important point is that the record of cancellation be with the GP practice as soon as is practicable. It is not necessary for that to take place physically at the practice, as that could potentially delay its delivery.
Stephen Kinnock
Clause 17(2) provides that where a notice or indication regarding a cancellation of a first or second declaration is given to a registered medical practitioner “at” the person’s GP practice, that practitioner must record the cancellation in the person’s medical records as soon as possible. Amendment 479 seeks to clarify that the requirement to record the cancellation applies not just where the cancellation is given to a registered medical practitioner physically at the GP practice, but where the cancellation is given to a registered medical practitioner “with” the person’s GP practice, irrespective of whether the notice was given at the GP practice. I hope that that explanation is helpful.
Kim Leadbeater
I commend the amendment to the Committee.
Amendment 479 agreed to.
Clause 17, as amended, ordered to stand part of the Bill.
Clause 18
Provision of assistance
Amendment made: 378, in clause 18, page 12, line 9, leave out paragraph (a) and insert—
“(a) a certificate of eligibility has been granted in respect of a person,”.—(Kim Leadbeater.)
This amendment is consequential on NC21.
Danny Kruger
I beg to move amendment 462, in clause 18, page 12, line 20, at end insert—
“(3A) When providing a substance under subsection (3) the coordinating doctor must explain to the person that they do not have to go ahead and self administer the substance and they may still cancel their declaration.”
The Chair
With this it will be convenient to discuss the following:
Amendment 463, in clause 18, page 12, line 34, leave out paragraph (c).
Amendment 497, in clause 18, page 13, line 9, leave out “decides” and insert
“informs the coordinating doctor that they have decided”.
This amendment provides that the duty to remove the approved substance arises on the coordinating doctor being informed that the person has decided not to self-administer the substance.
Amendment 498, in clause 18, page 13, line 10, leave out
“that the substance is not”
and insert
“to believe that the substance will not be”.
This amendment clarifies the circumstances in which the coordinating doctor is under a duty to remove the approved substance from the person.
Danny Kruger
This group of amendments contains two sub-groups that I shall deal with separately. Amendment 462, in my name, and amendments 497 and 498, in the name of the hon. Member for Spen Valley, concern the information given at the provision of assistance and decisions around that. My amendment 463 concerns the question of assistance in the final act.
This is a rather sombre moment in the Bill, because it is somewhere in clause 18, between subsection (9)(a) and subsection (9)(a)(i)—between the self-administration and “the person has died”—that the death happens. The amendments are about making sure that we understand what is happening here and whether it is safe.
Amendment 462 would require the doctor to make it clear to the patient at the final moment that they do not have to proceed. Of course, this is clearly the implication of the Bill. We have stressed autonomy all along. Everybody who is helping us to draft the Bill, all colleagues in the House and all doctors understand that of course the patient is not obliged to proceed at this point. The reason for the amendment is to think about the patient: to put ourselves in the mind of the person who has gone a long way down the road, who has summoned multiple professionals to endorse a decision that they have made and who has, we hope, involved their family and other people in their life, all of whom will be aware of what is about to happen and will, we also hope, be supportive of that decision or at least neutral about it.
That person finds themselves suddenly at the moment when the drugs are due to be set up for self-administration, a point that we will come on to. That is the final opportunity that they have to decline to proceed. Throughout the Bill, hurdles and gateways have been introduced through which a patient must proceed. In many respects I do not think them adequate, but it is acknowledged by the framers of the Bill that it is necessary to pass through certain hurdles and, in what might appear to be quite a formulaic way, require the patient to confirm and reconfirm that they have a clear, settled and informed wish.
What we do not have at this vital moment—in a sense, the only moment that matters, because everything up to this point has been preliminary; it is at this point that they step through the final gateway—is an obligation, expectation or requirement for any conversation to take place. The doctor is expected to satisfy himself or herself that the patient
“has a clear, settled and informed wish to end their own life”
and must be prepared to swear to that. Nevertheless, there is no expectation that they will have a conversation. We can pretend, imagine, hope or surmise that some kind of conversation would happen at that point—“Do you want to proceed?” “Yes, I do”—but we are not requiring it.
I raise this point in the clear and certain knowledge that many people do, at that moment, have second thoughts. We know that from the number of people who contemplate and get very close to the act of unassisted suicide and step back, literally, from the brink. I want to insist that there is an opportunity here to step back from the brink, just as our suicide prevention strategy seeks to ensure that at the moment when and in the places where many people tragically do take their own life, on bridges or on Beachy Head, there are signs saying, “Call the Samaritans” or “You are not alone”. I want to specify clearly that this is that moment, rather than it being assumed that the train has left the station and the person is just on it now. I think it would be a helpful amendment.
I cite written evidence from Dr Philippa Youd, writing in a personal capacity:
“I have witnessed ‘post-euthanasia regret’. I was 18 when my mother took her own life due to ‘interminable suffering’. She knew what she was doing—she had tried before. Just before she slipped into a coma, she told me she was sorry and that she regretted it. The inquest therefore deemed her death an ‘open verdict’. It was suicide, but it was suicide that was regretted, despite true intent and interminable suffering”—
and no doubt capacity and a lack of coercion. Dr Youd continues:
“No one can EVER be sure they want to die until the moment of death. They may still change their mind and then it is too late. No one can know what patients will truly face, emotionally and cognitively, at the point of death. I have witnessed firsthand the tragic circumstance of someone changing their mind after choosing to die. There is no peace in that.”
I hope that hon. Members will not consider that this amendment is unnecessary embroidery or that requiring a simple statement to be made is some kind of imposition on the autonomy of doctors or patients. Someone should still be able to turn back and change their mind at this point.
Kim Leadbeater
The hon. Gentleman is making a powerful speech, and I thank him for the respectful way in which he is doing so. He has given an example of a very personal story; it is also important to remember the other personal stories we have all heard. We have with us today in the Public Gallery family members who have lost loved ones. Catie’s mum went to Dignitas in Switzerland for an assisted death, and her daughter could not go with her. As a family they have suffered to this day as a result of that experience.
We need to be really careful about the language we use around suicide. We have spoken about this before. The cases we have heard of are not people who want to die. They are people who want to live, but they are terminally ill. We need to be really sensitive to that, having heard so many examples of families who have been through these really difficult situations. But the hon. Gentleman makes a very good point, and I am minded to support his amendment because I think it comes from a good place.
Danny Kruger
I am grateful to the hon. Lady. I hear what she has said; we have had this conversation before. I am afraid that I do insist on my right to use the English language accurately. What is proposed in the Bill is a carve-out of the Suicide Act, so I regret to say to the hon. Lady that I will continue to describe it in terms that are appropriate to it. I hope I do so with absolute sympathy and respect for the many families who have suffered from the trauma of seeing their loved ones die badly—loved ones who would have wished for an assisted death under the terms of the Bill. I am very glad to hear that the hon. Lady supports my amendment. I do not think it would be any sort of imposition on families for the doctors to let the patient know at the last moment that they have the opportunity to turn back.
Sean Woodcock (Banbury) (Lab)
The hon. Gentleman is making a really powerful speech, and I am minded to support the amendment on the basis that there will be a small but significant group of people who, having gone through the whole process, will feel they have been a burden on the people who have gone to all the effort, through every stage, to get to the end, so if they have doubts at the end, they may be reluctant to change their mind. It will be a very small group, but I do think it is significant. I see it as the re-establishment of autonomy for the patient, which we all believe in; does the hon. Gentleman agree?
Danny Kruger
That is absolutely right. We have to think about the no doubt quite turbulent emotions that people will have as they approach the end of their life, and to reiterate their genuine autonomy. They are not on a conveyor belt that they cannot get off until the very last moment—until they have passed through this gateway. The amendment seeks to remind them and, indeed, their families of that. I am afraid we do hear terrible stories of people who have arranged their assisted death: often family members have flown in from abroad, doctors have been summoned and so on, and then they feel they have to proceed because, as the hon. Gentleman says, they feel a burden as it is and do not want to be an annoyance at the end by making everybody wait. I am afraid that is indeed the reason for the amendment. I am pleased to hear that it sounds like it will be accepted, and I am grateful to Members who will support it.
Amendment 463 is the other, more substantial, amendment in my name in this group. It would leave out paragraph (c) of clause 18(6), which says that the doctor can assist the patient
“to ingest or otherwise self-administer the substance.”
Here we are in a lot of difficulty and a grey area. Let me try to unpack the reasons for objecting to paragraph (c). The hon. Member for Spen Valley argued in an interview that there is a “very clear line” between the Bill and euthanasia, which is someone else doing the deed. She said that the act
“has to be the decision of the individual, and it has to be the act of the individual”,
which
“creates that extra level of safeguards and protections”.
I agree with her—it is right that we introduce the additional safeguard of insisting that the patient performs the final act themselves.
I recognise that there is a distinction between euthanasia and assisted suicide, and I support the hon. Lady’s attempt to insist on that distinction in the law. It is another safeguard. But the fact is that there is a blurred line between the two, and I can also understand why many people object to the exclusion of euthanasia—of the fatal act being administered by other people. A doctor from Canada said it was inherently ableist to require the patient to self-administer, and I think that is unarguable. If that is the case, the logical provision would be to enable euthanasia, if one believes in the autonomy of the patient.
I am afraid my strong belief is that the reason why euthanasia has not been proposed in the Bill or by the campaign, which has been led by an organisation that used to call itself the Voluntary Euthanasia Society, is because the campaign has concluded that such a Bill would not pass Parliament and believes—I think correctly—that Members of Parliament and members of the public would object to euthanasia. But the logic of the Bill and of the campaign is actually for euthanasia, if one believes genuinely in autonomy, in equal rights and in not discriminating against people who are physically unable to perform the act themselves.
Despite my efforts, hon. Members have not been able to conceptualise the difference between withdrawing a medical treatment that affects a particular medical condition on the one hand, and administering drugs that annihilate the person on the other. There is a meaningful and important difference between those two things. One is a person declining to use a shield, and the other is the person using a sword against themselves. I think there is a difference there, and I regret that colleagues do not see it.
Where I do not see a difference, however, is between a person injecting themselves and asking someone else to inject them. There are two versions of the death of Saul in the Bible. I think this is the only reference to the Bible that I will make in this whole debate, and I make it partly to show that there is an inconsistency in the Bible—there is not a single Biblical view of these matters. In one account of the death of Saul, having been defeated by the Philistines, he asks his servant to run him through with his sword, but his servant refuses, so he falls on his own sword and kills himself. In the other version, he gets a passing soldier to run him through—to kill him.
To me it does not matter: the inconsistency in the story is interesting historically, but conceptually, logically and morally I do not see the difference. Whether you fall on your own sword or ask someone else to do it to you, it is still a sword, you are still actioning it and you are still responsible, if we recognise that the individual has autonomy. But there is a practical difference. We are talking about assistance to die and the role of another person who supports your decision and helps you to fulfil it, but that results in an obscuring of the practical difference. In practice, as we see in clause 18(6), the assistant comes very close to euthanasia. The role of the assistant, in my view, is closer to that of the soldier who kills Saul than of the servant who refused to do it.
Kim Leadbeater
The hon. Member is making an interesting philosophical point with his biblical references. I think the point he may be making is that there might not be any difference for the individual, as the result is sadly the same, but I put it to him that there is quite a significant difference for the other person. If we think about the autonomy of the medical professionals we ask to be involved in the process, there is a strong argument that it would be very different for them to be more involved in the process. Does that makes sense?
Danny Kruger
I am grateful—I really do thank the hon. Lady, because the effect of this process on the medical professionals who will be involved is a very important consideration, and one that we have perhaps not given enough attention to. That is why we will come to the conscience clause in due course, although we have discussed it a little already. The hon. Lady is absolutely right that there is a difference for the medics in the extent to which they are involved in the administration of the death. I am afraid I do not see a major moral difference between providing the wherewithal—setting things up for, or indeed helping, the patients to ingest or otherwise self-administer the fatal drug—and people performing the act themselves. The distinction is very obscure; there is a significant grey area there.
On the hon. Lady’s point about appropriate consideration of the feelings of the medical profession, if she believes in doctor autonomy, she should believe that doctors ought to have the autonomy to decide for themselves whether to perform euthanasia, if euthanasia were legal. That is what happens in other countries. In Canada, doctors can decline to take part, or they can participate.
Given the question of autonomy, it is worth noting that in countries where euthanasia is legal, it is the overwhelming choice of the patients, as I think it would be for me. If I were facing that terrible moment and choice—we will come in due course to the question of the drugs involved and the process of taking them, but swallowing all these pills is not a pleasant process—it would be far easier, more humane and less painful for a doctor to administer the drugs intravenously. I visited Canada and met a doctor who had been responsible for over 300 deaths, which she herself has performed, because that is the overwhelming choice of the patients. As I am sure the hon. Lady would agree, that doctor is acting with full professional discretion and autonomy.
To go back to my point, I am afraid this is one of the impossible dilemmas that the Bill and the whole concept of assisted dying set up: whether we allow the doctor to do it to us. My concern is that if the stress on self-administration is genuinely felt—not, as I cynically believe, because this is the only way to get assisted dying through the House of Commons—because the Bill’s authors recognise the need to be absolutely sure that the act is voluntary, and if the reason why we insist on self-administration is because we want to be sure that the act is voluntary, what does that say about all the so-called safeguards that exist up to this point? We have been told that those safeguards are sufficient to ensure that we have absolute confidence about the person’s clear and settled wish.
If we are sure that people at this stage in the process have a settled, informed and free wish to end their lives, why should they not be able to ask a doctor to do it to them? The only answer to that question can be that we do not genuinely believe that we are completely sure. We want, subsequent to death, to be sure—in terms of our own moral propriety and sense of amour-propre—that those people did it themselves. It was not our choice; it was not us doing it to them—they did it.
Kit Malthouse
I am a little confused by my hon. Friend’s logic. He has literally just proposed an amendment for the doctor to ask, at the last, whether the person still wants to proceed. Surely self-administration is the ultimate act of consent, which his own amendment requires a doctor to establish right at the last moment.
Danny Kruger
My right hon. Friend is absolutely right. I support the distinction between self-administration and euthanasia. I am in favour of all possible safeguards and every possible opportunity to give the patient the chance to step back from the brink. The point I am making is that I do not recognise the logic of the distinction that the Bill insists on. Indeed, in the provision that I am concerned about, subsection (6), the distinction in fact does not apply.
If we believe in autonomy and in giving people the opportunity for assisted suicide, we are, naturally enough, concerned that that should be available to people who cannot physically perform the act themselves. I am not trying to argue in favour of euthanasia; I am saying that we will get to euthanasia if we let the Bill through. Even in the Bill as it stands, we are halfway to euthanasia with subsection (6). I am confident that, in due course, the campaign for it will grow. In fact, it already exists: people already object to the restrictions implied in the Bill. The campaign will grow to widen the opportunity for assistance to ensure that we can have physician-administered suicide, as happens in Canada and elsewhere, very logically. Once we have crossed the Rubicon of assisted death, it is a straight road to euthanasia. [Interruption.] I am sorry that the hon. Member for Stroud is amused.
Sojan Joseph
Will the hon. Gentleman clarify something? He is making a valid point, and I have been thinking about it. As a nurse who has worked in many areas, I know that a disabled person may not be able to take medication by themselves, and sometimes a nurse has to administer it with a spoon. There may be occasions on which a person’s medication comes back out and they have to do it a few times. Is that something the hon. Gentleman is concerned about—actually pushing the medication into the person?
Danny Kruger
Once again, we are in an extraordinary no man’s land between medical treatment and something else that we cannot find a word for. The hon. Gentleman is absolutely right. Of course, it is appropriate in medical treatment for a nurse or doctor to assist in the administration of a treatment. As he suggests, if the person found it difficult to raise a cup to their lips, the nurse would help them. Indeed, if they found it difficult to perform an injection, it would be expected that that would be done by the nurse or doctor anyway. But here we are setting up a strange new method of administering a so-called treatment in which the patient has to perform the physical act themselves.
It is apparent from the clause that it is very unclear what assistance actually looks like, so yes, I absolutely imagine that if the patient were struggling to raise the cup to their lips, a nurse or doctor who was present at the final act in an assisted suicide would help them to do so. Similarly, if the patient were finding it difficult to put their finger on the syringe, it would be appropriate—normally, one would expect—for the medical professional to lift the patient’s finger and put it in the right place. What happens next? Do they then apply a little pressure if the patient is finding it difficult to depress the plunger on the syringe? If the cup is at the lips, do they tip it up and let gravity take its course? These very complicated questions about where assistance ends and autonomy begins are, I am afraid to say, impossible to specify in the Act; therefore, it is apparent that we have a grey area.
I conclude with some evidence that we received from Iain Brassington, professor of applied and legal philosophy at Manchester University. He says:
“how are we to determine how the ‘final act’ of self-administration is to be differentiated from the penultimate act, in which the doctor may assist? How would helping a patient lift the cup to her lips be distinguished from helping her ingest its contents?”—
the hon. Member for Ashford referred to that. He goes on to say that
“the definition of the ‘final act’ is unclear, especially granted the wording of”
subsection (6)(c), and:
“The proposed law says that a doctor may not administer a substance with the intention of causing death, but also that a doctor may help a person self-administer. But how should we draw the boundary between helping a person self-administer, and playing a role in administration?”
I come to the penultimate point—not the final act—of my speech. There is some odd phrasing in subsection (7), and I wonder whether the hon. Member for Spen Valley or the Minister can help to parse the English. It says that
“the decision to self-administer the approved substance and the final act of doing so must be taken by the person”.
We understand about the decision being taken by the person, but the phrasing is that the final act “must be taken” by the person. I am not familiar with that construction. Does one take an act? Is that English? You perform an act—an act is not taken, it is done, by a person acting autonomously. The question of whether this is an active or a passive concept runs to the heart of my concern about the clause, and we need to think about redrafting, at least in deference to the English language.
Somewhere in this clause there is a magic moment when assistance gives way to autonomy, and the penultimate act by the doctor yields to the final act, which is supposed to be by the patient. We cannot tell when the responsibility for the action passes from one to the other. In proper medicine it does not matter because the medic works with the patient, but here it does matter. We are insisting that there is a difference between a doctor setting up a death, and the patient performing the action of suicide.
I will end by referencing the case of R v. Kennedy in 2007, a case on which Lord Bingham opined, about the culpability of someone who died from a heroin overdose. Was the person who gave him the drugs and tied the tourniquet around his arm responsible? Was it murder, or indeed assisted suicide? The judge decided that it was not, but made this point:
“It is possible to imagine factual scenarios in which two people could properly be regarded as acting together to administer an injection.”
Given that ruling, we are in a world of difficulty with the suggestion that it is legally possible for a doctor to assist a patient to ingest or otherwise self-administer. To assist someone to self-administer is tantamount to administering. I welcome suggestions from other Members, the Minister, or the hon. Member for Spen Valley about whether it is possible to provide guidance that gives greater clarity on what the clause means, or whether subsequent amendments will help to resolve the problems that I have, but I am afraid I do not think it will be possible to make an adequate distinction between assisted suicide on the one hand—in which full responsibility, not just for the decision but for the performance, rests with the patient—and euthanasia on the other. I do not think there is an adequate logical difference, and the practical difference we are attempting to enshrine here will be very quickly obscured.
Naz Shah
I thank the hon. Member for East Wiltshire for his amendment, and for speaking in the powerful, sensitive way that he did. I also thank my hon. Friends the Members for Spen Valley and for Banbury, who made interventions.
I did not intend to speak to this amendment, but having heard the hon. Member for East Wiltshire speak so powerfully and sensitively, it is important for me to share a few things. My hon. Friend the Member for Spen Valley has said a couple of times that the difference between people who commit suicide and those who will take this route is that the patients have been given less than six months to live, and that was not a choice. I was a Samaritan for years, because I had two failed suicide attempts in my early years, and since then I have battled with mental health demons all my life because of my experiences. To suggest that there is a difference between someone who gets a terminal illness and wants to take this act and people who want to commit suicide, and to suggest that they are doing it out of choice, is wrong. I felt really emotional when that exchange was happening. The reason why I think it is wrong is that, at the time that I wanted to commit suicide, I did not feel that I had a choice. I could not see a way out.
When I was on those Samaritans phonelines, speaking to people who rang in to unpick their feelings about what was driving them to feel suicidal in that moment, it was not because they want to die, but because they were in circumstances that drove them to feel that they had no option but to commit suicide. In some instances, it takes an amount of courage and bravery to even contemplate that option. To diminish that, which I feel is what has, intentionally or unintentionally, happened on occasion, is really wrong, because I have been there, and it was not easy and it was not because I wanted to die.
Kim Leadbeater
My hon. Friend makes a powerful point. I certainly have not heard anyone try to diminish the experience of suicidal people. We probably all have our own stories of loved ones who we have either lost to suicide—I know that I do—or who had very severe mental health issues. The point I would make is that the families I have met who have lost loved ones through assisted dying or a harrowing terminal-illness death have said that they desperately wanted to live. That is the distinction I would make, but I appreciate that my hon. Friend is absolutely right that people with suicidal tendencies and ideation also want to live—they just do not feel they have a choice. It is a very delicate debate to have, but please be assured of my sensitivities to it.
Naz Shah
I am genuinely grateful for my hon. Friend’s intervention, because I do not want the Committee—or our constituents—to feel that there is an equivalence. There is not. People who are in that space, who ring the Samaritans helpline to speak to them, all desperately want to live a brilliant life. That is what brings us here: each and every one of us wants to make this place the best it can be, so that our country is the best it can be and all our communities, people and constituents—all members of society—thrive. It is a sensitive debate, but let us be careful not to draw a parallel where there is not one. It was important for me to put that on the record.
I will support the amendment tabled by the hon. Member for East Wiltshire because we have already voted down an amendment requiring doctors to simply ask the question why. This speaks to the point that my hon. Friend the Member for Banbury raised: I know, through my experience at the Samaritans, as somebody who has attempted suicide and as somebody who has gone on to chair a charity that leads mental health interventions, how difficult it is for a patient has gone through the process of having had that conversation with their family, who might not necessarily agree, and having convinced them that they are going to take this option because they want autonomy, and fear losing it.
I cannot imagine what it must be like for those people, at that moment, saying their final goodbyes, and the level of potential pressure they face right at the last minute, having spoken to everybody and put their family members, and indeed themselves, through the process. Would they not feel internal pressure on themselves to go through with it? Would they really have the option, and not feel, in a sense, obliged to say, “Yes”? Do we really not want to ask that question?
When we debated the amendment requiring doctors to ask the question why, my hon. Friend the Member for Stroud said that doctors would ask it anyway, but that argument would not work in this instance because doctors would not do this anyway. They would not say, “I am about to give you something—have you changed your mind?”, because by that point they are in a process. The drug, in whatever form it takes, is in the process of being, or will have been, handed over to the person who wants to take that option, so it is not the same. I genuinely hope that the Committee will support the amendment, because it is our last option to make this intervention.
Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)
It is a pleasure to serve under your chairmanship, Ms McVey. I will speak briefly to this group of amendments, setting out why I support amendments 462, 497 and 498, but oppose amendment 463. My hon. Friend the Member for East Wiltshire set out very eloquently the reasons behind amendment 462. On the one hand, there is a cogent argument that it is not strictly necessary in the light of the provisions set out in subsection (4)(b) and (c), which set out that the individual wishing to have an assisted death must have
“a clear, settled and informed wish to end their own life”
and is
“requesting provision of that assistance voluntarily”.
However, it appears to me a logical and entirely appropriate extension of the intentions behind clause 18(4) to express that in slightly more explicit terms in the Bill by adopting my hon. Friend’s amendment 462. It strikes me that, after doing so, the Bill would provide a further check and balance that creates no greater onus on either the individual seeking an assisted death nor the co-ordinating doctor who is assisting them. In those circumstances, it appears eminently sensible to improve the Bill in that way. From the indications we have already heard, it appears that there is significant support for that amendment.
I struggle with amendment 463, which would remove paragraph (c) from clause 18(6). The effect would be to prohibit the co-ordinating doctor from providing assistance to the person seeking an assisted death, either through ingestion or other self-administration of that substance, in any circumstance. In my view, the amendment would make the operation of the Bill, were it to become an Act, unnecessarily restrictive. Clause 18(7) already stipulates that
“the decision to self-administer the approved substance and the final act of doing so must”—
I stress the word “must”—
“be taken by the person to whom the substance has been provided”.
On any interpretation of the construct of that, it is clear that the person seeking an assisted death must be the active participant in the process; it is mandatory. There is no discretion in that, by virtue of the word “must”.
Were we to remove clause 18(6)(c) and the Bill passed into law, it would have the effect, in what is an entirely legal process, that a doctor would be unable to aid a patient in any circumstance. For example, they would not be allowed to hold a glass or steady a straw as a patient moved towards it to imbibe a substance. Those are circumstances that are entirely foreseeable, when through the ravages of an illness, somebody is limited in what they are physically able to do. Of course, assistance could be provided in alternative ways—for instance, through assistive technology, which we have seen being used in other jurisdictions. The Swiss, for example, use a significant amount of assistive technology in administering and assisting the process of self-administration at the end of life.
Danny Kruger
My point is that it is very difficult to draw a line here. I recognise the scenario that my hon. Friend raises: why should a nurse not be able to hold a straw for a person to drink from? I might say that should be acceptable; however, I do not think it should be acceptable for the nurse to tip the pills into the patient’s mouth. Does he think that scenario would be acceptable? Or to give another one, would it be acceptable to actively provide force on top of a patient’s finger to press a syringe? Would he regard that as acceptable assistance?
Dr Shastri-Hurst
That is why clause 18(7) is so important: the final act must be undertaken by the person seeking an assisted death. The example my hon. Friend gives of tipping tablets into a mouth is a final act. Pushing a syringe is a final act. There is a significant distinction between an individual or practitioner holding a cup with a straw and the person seeking an assisted death moving their mouth towards the straw, sucking from it and imbibing the substance and the passive act of a substance being raised to that individual’s lips and poured in without any movement by the individual seeking an assisted death themselves.
Danny Kruger
When we talk about this in future debates, it might be appropriate for this conversation to be referenced. I think my hon. Friend is suggesting that it should be acceptable, and that assisted death would be legal, as long as the patient moved their head towards the straw and cup, and that it would be illegal, according to my hon. Friend’s definition, were a doctor applying a cup to a patient’s lips and the drugs fell in by gravity. Is that right? Is that how judges in future should determine whether assistance has crossed the line?
Dr Shastri-Hurst
It is very clear from subsection (7) that this must be an active step taken by the individual. There is a risk that we go down a rabbit hole in terms of—[Interruption.] I am sure my hon. Friend would like me to finish my point. We risk going down a rabbit hole in drawing examples. I raised the example of a cup, but of course there are much wider assistive technologies that can be used and are used in different jurisdictions. I gave the example to illustrate the point that this is an active act, not a passive act.
Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
The hon. Gentleman mentions subsection (7). Subsection (8) states quite clearly that it
“does not authorise the coordinating doctor to administer an approved substance to another person with the intention of causing that person’s death.”
I think the passive and active roles are quite clear between the two subsections.
Dr Shastri-Hurst
I agree entirely with the right hon. Member’s interpretation of the Bill.
There is a further unintended consequence of the amendment tabled by my hon. Friend the Member for East Wiltshire, which I am sure is not his intention but would sadly be the effect: were an individual to qualify under the Bill, should it pass and were the amendment to be adopted, they would inevitably be forced to take the final decision at an earlier stage. If there is a restriction that they can have no assistance whatsoever in performing the act, they will end up making the decision when they know that they have the entire physical strength available for them to do it, and that actually brings forward the point at which they choose to die to an earlier stage.
Kit Malthouse
After 10 years of campaigning on this issue and spending so much time with people whose family have gone to Switzerland, one of the things they consistently say is that people went to Switzerland much earlier than they wanted to because they had to go while they were still physically able. I think this is a critical point that people have to realise. We should not compel people to do this earlier than they would otherwise wish to simply because of these restrictions.
Dr Shastri-Hurst
My right hon. Friend makes an important and powerful point. I think there is a consensus among the Committee that there is no desire for people to take this ultimate step at an earlier stage than is absolutely necessary for them. My very real fear is that, were we to adopt this amendment, we would bring forward that point of decision.
Danny Kruger
The logic of that argument is to allow physician-administered suicide, because there will be a point at which people are physically unable to perform the act but have capacity, and their autonomy should be respected—
Border Security, Asylum and Immigration Bill (Eleventh sitting)
Tuesday 18th March 2025
(2 days, 11 hours ago)
Public Bill CommitteesBorder Security, Asylum and Immigration Bill 2024-26 View all Border Security, Asylum and Immigration Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 18 March 2025 - (18 Mar 2025)
The Committee divided: - Ayes: 2 / Noes: 12 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 13 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 12 - Question accordingly negatived.
The Chair
Good morning, everyone. Would everyone please ensure that all electronic devices are turned off or switched to silent mode? We will continue line-by-line consideration of the Bill. The grouping and selection list for today’s sittings is available in the room and on the parliamentary website. I remind Members about the rules on declaration of interests, as set out in the code of conduct. I also remind Opposition Members that if one of your new clauses has already been debated and you wish to press it to a Division when it is reached on the amendment paper, you should let me know in advance, please.
New Clause 24
Immigration Tribunal: hearings in public
“(1) The Nationality, Immigration and Asylum Act 2002 is amended as follows.
(2) In Schedule 5, after subsection 5, insert—
‘(5A) All hearings of the Tribunal must be heard in public, and all decisions delivered in public,’”.—(Matt Vickers.)
This new clause would require all rulings in the Lower Tier immigration tribunal to be heard in public.
Brought up, and read the First time.
Matt Vickers (Stockton West) (Con)
I beg to move, That the clause be read a Second time.
It is a pleasure to serve under your chairmanship, Dr Murrison. The Conservative party has tabled the new clause to ensure that proceedings of the lower-tier immigration tribunal will be heard in public. We have seen absurd outcomes in some of the cases heard in the upper tribunal in recent months, and we feel it is important to make sure that the system is transparent and that the public have full access to the tribunal records at both levels.
Examples of recent cases reported by the Telegraph include that of an Albanian criminal who avoided deportation after claiming that his son had an aversion to foreign chicken nuggets, and that of a Pakistani paedophile who was jailed for child sex offences but escaped removal from the UK as it would be unduly harsh on his own children. More recently, it was reported that a Pakistani man was convicted of sexually assaulting a woman but was allowed to stay in Britain after he claimed he was gay. An Albanian criminal also avoided deportation after a judge ruled that long-distance Zoom calls would be too harsh on his stepson.
The absurdity is further emphasised by the case heard recently in which a Ghanaian woman won the right to remain in Britain as the wife of an EU national, even though neither she nor her husband was present at the wedding held in Ghana. The lower-tier tribunal stated that the marriage was not legal, but that was overturned in the upper tribunal, which ruled that the proxy marriage was recognised in law and that registration at the same time as the marriage ceremony was not mandatory.
The continued abuse of our legal system, and the use of human rights as a defence, has gone on for too long. In another case, a tribunal ruled that a convicted Ghanaian pastor who was deported from Britain for using fake documents should be free to return to the country. Despite being jailed for using illegal documentation, the individual in question appealed under article 8 of the European convention on human rights, leading a judge to revoke the deportation order, claiming that it was an “unjustifiable interference” in his human rights.
The number of decisions may be used as an argument against the new clause, but these decisions are important. The first-tier tribunal’s asylum appeal backlog increased from 34,234 outstanding cases at the end of September 2024 to 41,987 by the end of December. That contrasts with 58,000 in the first quarter of this year. That is significantly more than the upper tribunal, but it underlines the importance of us knowing what has happened in these cases. Public trust is pivotal, as it—
The Minister for Border Security and Asylum (Dame Angela Eagle)
It is a pleasure to see you in the Chair, Dr Murrison—I suspect that you will be bookending our proceedings, if we make reasonable progress today. Does the shadow Minister acknowledge that increases in appeal backlogs are a result of the legacy process that his Government undertook, because people whose claims were not granted in that process have appealed and added to the backlog?
Matt Vickers
We know that significantly more people are arriving in the country. In fact, since the election, the number arriving illegally is up 29%, as is the number of people staying in hotels. The Government are actually removing fewer people than arrive by small boat now. The more people arrive, the more the backlogs will become an issue. Transparency in these tribunals is essential.
Jo White (Bassetlaw) (Lab)
I am really trying to get my head around the new clause. Why would decision making in public be different from decision making in private?
Matt Vickers
Public trust in these decisions is completely and utterly broken. The answer to that is not to allow a good chunk of them to go unseen by the public. The public deserve to see and the people making the decisions deserve to be held to account. We need to ensure that the law is fit for purpose. We need to see the impact of the Human Rights Act 1998 and the ECHR. That needs to be there for all to see. Public accountability and transparency are a good thing. The taxpayers out there, who fund all this, have a right to know what is going on, at any level, in the tribunals.
Tom Hayes (Bournemouth East) (Lab)
It is a pleasure to serve under your chairpersonship, Dr Murrison. I agree that there is a lack of trust in our immigration and asylum system, but does the hon. Member agree that the cause of that is not the conduct of courts in public or private, but the backlogs that have been created and the inability of the Conservatives to tackle the problems in our immigration and asylum system? Will he also reflect on the fact that the Conservatives in government had the opportunity to introduce this change but chose not to? Is he perhaps playing a bit of politics?
Matt Vickers
We have seen what has happened since the election. We will not go into the fact that numbers are up significantly, and whether the number of people arriving by small boat is down significantly, but actually, regardless of when it is changed, here is an opportunity, with a piece of legislation, to change this. The trust that the public have in the system is completely battered by these decisions, so it is right to have that transparency. The answer to the need to build public trust is not to hide a good chunk of what is going on, but to let more people see it. The light of day would be very good at getting rid of some of this toxicity, holding people to account and ensuring that the legislation that we have tomorrow is fit for purpose. As parliamentarians, we should be held to account for the legislation that we are putting forward. We should be held to account for its consequences, including in the tribunals that are making so many decisions on these cases.
Public trust is pivotal when advocating for Opposition new clause 24. It transforms the subject of the debate from a dry procedural tweak into a fundamental issue of democratic accountability. The British public’s faith in the immigration system has been battered by the bizarre tribunal rulings highlighted earlier—decisions hidden behind closed doors that defy common sense and insult victims. By mandating public hearings at the first-tier tribunal, we can signal that justice is not just for claimants but for taxpayers, who fund it.
Mike Tapp (Dover and Deal) (Lab)
The hon. Member has a lot to say in Opposition, but the big question is: why did he not do this when the current Opposition were in government?
Matt Vickers
We were doing lots of things. I am sure we will come on to some of the progress that was being made, including the Albania agreement, which has taken thousands and thousands of people back to Albania and reduced the number of people coming. That deterrent stopped people setting off in the first place. It was real progress.
The Bill—this is the reason why we are sitting here today—is the opportunity to shape what comes next, what impact that will have on the number of people coming across the channel and what impact that will have on public confidence in our courts system. That is what we are here for. It is why we have bothered sitting here for so many hours—to ensure that the legislation that goes forward tomorrow is fit for purpose.
Matt Vickers
Well, we will see how much longer we get to sit. Time will tell, but I will move on.
Tom Hayes
The hon. Member is making a very powerful point about the importance of restoring trust and, to be fair to him, he has been making that point for many years. On 20 July 2021, he said in debate on the Nationality and Borders Bill:
“Our asylum and immigration system is not fit for purpose. It lines the pockets of criminal gangs and people smugglers, and it is not fair on genuinely vulnerable people who need protection. It is also not fair on the British public, who pick up the tab.”—[Official Report, 20 July 2021; Vol. 699, c. 902.]
I agree entirely with the hon. Gentleman about what happened in 2021, 2022, 2023, 2024 and, in fact, the years before that. Does he agree with the 2021 hon. Member for Stockton South, as he then was, that in fact the cause of the mistrust in our asylum system is the management of it, not what he is trying to address here?
Matt Vickers
I am glad the hon. Gentleman is a fan; I made an effort today with the tie. I think I was speaking as much common sense then as I am today. I agree that the system does not work. That is why we are here. It is why I hope these proposals will make a difference. It is why we are trying to improve the system. And that is why I think we should have transparency in these tribunal outcomes.
As I said, we are talking about decisions hidden behind closed doors that defy common sense and insult victims. By mandating public hearings at the first-tier tribunal, we can signal that justice is not just for claimants, but for taxpayers who fund it and citizens who live with its consequences. Transparency exposes these absurdities, has the potential to curtail judicial overreach, and could reassure a sceptical public that the system prioritises their safety and fairness over secretive leniency, because trust, once lost, is hard to rebuild.
It is only right that the general public, who foot the bill for these cases time and again, are allowed to fully understand what their money is being used for. It is only right that the public can see these sessions so that there is a place for scrutiny and accountability. It is only right that such a shameful abuse of the UK’s legal system be exposed to the taxpayers of this country.
Mike Tapp
It is a pleasure to serve under your chairmanship, Dr Murrison. The hon. Member for Stockton West has made a creative argument, and I will try to bring some sense to it. First, we have to look at what the new clause would actually do for the country and our judicial system. Public hearings could expose vulnerable individuals, including victims of persecution or trafficking, to undue public scrutiny, which could deter genuine applicants from seeking justice. There are also security risks. Sensitive information about applicants’ backgrounds, including details that could endanger their families in their home countries, could be exposed.
There is also the risk of the legal system being overloaded further, given what we have inherited. Increased public interest in the hearings could lead to more appeals and challenges, which would cause more delays and inefficiencies in the system. Finally, the new clause is simply unnecessary as courts already have the discretion to allow public access when appropriate. It would remove vital judicial flexibility.
Katie Lam (Weald of Kent) (Con)
It is a pleasure to serve with you in the Chair, Dr Murrison. After years of broken promises, it should come as no surprise that the public do not trust politicians in Westminster on immigration. The distrust is compounded by regular reports of individual cases in the immigration system, the most shocking and nonsensical of which are often those of foreign criminals allowed to remain in this country due to human rights laws.
The system is broken. It has been broken for many decades, and that is now plain to see. Our basic decency—our desire to do the right thing—is exploited by paedophiles, rapists, terrorists and hardened criminals, who threaten not just individual members of the public, which is terrifying enough, but the broader social fabric of our country. The news reports that we read are possible only because upper tribunal judgments on asylum and immigration are published at regular intervals. The publication of those judgments allows everyone in the country to see what tribunal judges have decided in asylum, immigration and deportation cases. Crucially, it allows us to scrutinise both their decisions and their reasoning. We can see why the judgments were made and what that says about our laws, and decide for ourselves whether we think that is right. Judges are not accountable to the public, but transparency allows everyone to see our laws in action and to form a view about whether they are the right ones.
However, upper tribunal judgments do not tell the full story. All immigration and asylum cases are first heard by a lower-tier tribunal, the judgments of which are not made available to the public. Unless the initial decision of the lower-tier tribunal is appealed, the public do not ever get access to the details of any given case. Given the absurdity of the cases that we do hear about, many members of the public will rightly be wondering what is happening in the cases that we do not see.
If we want to restore public trust in the immigration system, we must restore transparency. Publishing the decisions of lower-tier tribunals is not the biggest or most consequential change in the grand scheme of our broken immigration system, but it is a meaningful one. The public have a right to know about the way our tribunal system works, to know about the rules judges use to make fundamental decisions about immigration and asylum—about who can be in this country and why—and to see how those rules are applied in practice so they can decide for themselves whether that is right or wrong and whether it serves Britain’s interests. That is why we tabled this new clause, and we sincerely hope that the Government will consider making it part of the Bill.
Margaret Mullane (Dagenham and Rainham) (Lab)
It is an honour to serve on your Committee, Dr Murrison. I do not see how turning border security into public discourse on a case-by-case basis is beneficial to the process, either for those administering or presiding over the hearings, or for those subject to the tribunal process. I accept that there is an argument for greater transparency, but given the circumstances of people’s arrival at our borders—they are fleeing trauma, in a vulnerable state—I feel it is inappropriate to parade the lives of asylum seekers in the public domain.
I have every faith that the Bill will create a robust system that is effective and accountable. The new clause would add nothing to its overall strength. The hon. Member for Stockton West says that trust has been lost in the asylum system. I think it will take this Bill and this Government to bring that trust back.
Dame Angela Eagle
I have to compliment the hon. Member for Stockton West on his tie, since he raised it, and the hon. Member for Weald of Kent seems to have good taste in the colour of her jackets. I promise that that is the last fashion statement that I will make in our proceedings today.
On new clause 24, we agree that accountability and transparency are absolutely vital for building trust and credibility in the immigration system. Under rule 27 of the Tribunal Procedure (First-tier Tribunal) (Immigration and Asylum Chamber) Rules 2014—note the date—the presumption already is that hearings at the first-tier tribunal must be public unless the first-tier tribunal gives a direction that it or part of it is to be held in private. Indeed, the majority of hearings at the first-tier tribunal are public. However, there are sometimes appropriate reasons for a hearing not to be public. For example, hearings may be held in private to preserve confidentiality in respect of sensitive medical details or to protect the privacy of a victim of a serious crime—for example, of a sexual nature. It may also be done to protect a party or witness from duress.
That is precisely why the Tribunal Procedure Committee has broad discretion to determine what practice and procedure in the first-tier tribunal will best support the overall interests of justice, and why the judiciary has a range of case management powers under the tribunal procedure rules to decide how individual cases should proceed. Those tribunal powers were published and written when the party of the hon. Member for Stockton West was in government, in 2014. It is expected that judges will have a wide discretion in dealing with these sensitive issues.
On making rulings of the first-tier tribunal available to the public, currently judgments of the immigration and asylum chamber of the first-tier tribunal are not routinely published. The decision about whether to publish a judgment is a judicial one. However, members of the public and the media can apply to the tribunal for a copy of the judgment in a specific case. I know that the Lord Chancellor will continue discussions with the judiciary about how we can bolster accountability and transparency to build public confidence, but I cannot help feeling that perhaps certain people who might work for a certain newspaper are getting to the end of their search engines for absurd cases that they can publish, and want a whole new database to search. If they want to bring these issues out into the open at the first-tier tribunal, perhaps they should send some reporters to listen to the case or apply on an individual basis for the judgment to be published. Perhaps that might assuage their ongoing interest in these issues.
Matt Vickers
I thank the Minister for her opinion, but we stand by this new clause. We want greater transparency, and we think this is an opportunity to do just that and allow the public to see what is and is not going on, so we will press it to a Division.
Matt Vickers
I beg to move, That the clause be read a Second time.
The Conservative party is clear that the ability of immigrants to remain indefinitely in the United Kingdom and to acquire British citizenship should be not an automatic right, but an earned privilege, reserved for those who have made a real commitment to the UK. New clause 25 would increase from five to 10 years the period before a person can claim indefinite leave to remain, and add conditions to ensure that those applying for indefinite leave to remain have not claimed benefits or relied on social housing while here on work visas. Those claiming indefinite leave to remain must also be able to demonstrate that their household would be a net contributor and that they do not have a criminal record.
It is only right that individuals prove they have made a positive contribution to the United Kingdom and that their place in society is justified. For too long, the United Kingdom has been seen to have an open door policy, and this has been abused. Enough is enough. The 10-year rule would prove commitment—five years lets you settle; 10 years lets you prove you belong. It is enough time for people to learn our language, adopt our values and pay their dues.
Tom Hayes
This proposal has emerged before the Leader of the Opposition sets in train her new policy commissions, including one on immigration, so it is good to get a teaser today. Under this proposal, will a person who would seek to apply for indefinite leave to remain after 10 years be required to apply for limited leave to remain every 30 months?
Matt Vickers
The hon. Gentleman has got me. I was hoping he was going to spout some more of the common sense that I have contributed to Hansard.
Tom Hayes
I might be able to help the hon. Gentleman. The IPPR, which listens to the voices of migrants, asylum seekers and refugees navigating that 10-year process—people who look to settle here legally—and which looks at the data, published a report, “A Punishing Process”, which talks about some of the administrative costs and difficulties of the process. As part of the Leader of the Opposition’s new commission on immigration, will the hon. Gentleman be able to provide an assessment of the true cost to the Home Office of an individual applying for LLR every 30 months? Will he would maintain the requirement that people have to pay £2,608 as an adult and £2,223 for a child in visa fees? One of the concerns of the IPPR report is that poorer people often get pushed into greater poverty by having to apply every 30 months.
Matt Vickers
We have processes in place that determine this, and they do come with a cost. However, the cost to the British taxpayer of allowing this to go on unabated is that much greater. There are processes in place and there are costs attached to them, but there are huge costs attached to allowing people indefinite leave to remain on shorter terms than we are suggesting.
Matt Vickers
There is huge cost. I will come to what the cost will be in the next few years of the number of people who are about to gain indefinite leave to remain.
Matt Vickers
No, I will not give him the name of the report.
Applying the 10-year rule, rather than the five-year rule as now, would prove commitment. As the shadow Home Secretary, my right hon. Friend the Member for Croydon South (Chris Philp) said:
“A British passport is a privilege, one that has been debased by benefit tourism for too long. Our plan gets it right, making sure that those who pay their way get to stay.”
The Prime Minister, bizarrely, does appears to think that British citizenship is not a pull factor, so much so that the Government are seeking to repeal swathes of the Illegal Migration Act 2023 passed under the previous Conservative Government. In doing so, this Government will scrap rules that meant that almost all those who entered the United Kingdom illegally would not be entitled to British citizenship, and that asylum seekers who failed to take age tests would be treated as adults. Those were common-sense policies. We are calling on all parties, and especially the Government, to support this new clause. We need to ensure that everyone who comes to this country is willing to contribute and to integrate into our society.
Chris Murray (Edinburgh East and Musselburgh) (Lab)
It is a pleasure to serve under your chairship, Dr Murrison. Madeleine Albright, the former US Secretary of State, was first a refugee in the UK, and she said that, in Britain, people would say to refugees, “You’re welcome here…and when are you going home?” whereas, in America, they said, “You’re welcome here…and when will you become a citizen?” Does the hon. Member not think that the problem the last Government created was that they moved to a high-churn model of migration, with huge numbers of people coming in, working in low-paid jobs, not integrating and then leaving, and more people coming in? We want to incentivise people to learn the language, engage with our institutions and follow our rules, which means that pathways such as this are really important, not the model that we have seen for the past 14 years.
Matt Vickers
The principle here is that we are saying, “You will get indefinite leave to remain, not after five years but after 10 years.” We have already had the debate about British citizenship and what that means—all the benefits that come with it and all the costs to the taxpayer that are attached to it. I therefore I think that this principle is right: if someone is going to stay here, they have to have been here longer, earned their keep, contributed and integrated properly. I think that 10 years allows that. I think that this is the way forward, and I stand by it.
Tom Hayes
I thank the hon. Member for his patience in allowing me to intervene again. Is it not fair of the Government to accept only those amendments whose details are actually known and worked up; and is it not, therefore, unfair of the hon. Member to press a new clause when he has not worked out the details of what its implementation would look like?
Matt Vickers
The details and the need for people to engage with the authorities are already in place. This new clause is literally about saying “10 years” instead of “five years”. No part of it amends existing provisions regarding migrants’ responsibility to account for themselves during that period. There is no suggestion of any change to that; it is beyond what we are amending through the new clause. If we wanted to change that, there would certainly be a debate to be had, and there would probably be opportunities to bring forward amendments, but that is not what we are proposing here. We are proposing to increase the period from five to 10 years.
Our country is our home; it is not a hotel. We can guess what the Government’s response to this will be—more deflection and criticism—but they must remember that they are in government now and have a duty to protect the British taxpayer from unnecessary costs. If they do not act, every UK household is forecast to pay £8,200 as a result of between 742,000 and 1,224,000 migrants getting indefinite leave to remain in the next couple of years. The Government must act to ensure that everyone who stays in the country is a net contributor.
It may interest the Government to know that changes to indefinite leave to remain have happened before—and can and should happen again now. In 2006, under the then Labour Government, the Home Secretary extended the time required to obtain indefinite leave to remain from four years to five years, an extension that applied retroactively to those already actively pursuing indefinite leave to remain. It is hoped that this Government will make a similarly bold move and support new clause 25.
Before the accusations start to be thrown around, let me make it crystal clear that new clause 25 is not some cold-hearted exercise in exclusion; it is a robust, principled stand for expectations—a line in the sand that says that if someone wants to live here, stay here, and call Britain their home, that comes with a reasonable cost. That cost is not measured just in pounds and pence, but in commitment, in responsibility, and in proving that they are here to lift us up, not weigh us down.
A recent study undertaken by the Adam Smith Institute found that, according to figures produced by the Office for Budget Responsibility, the average low-wage migrant worker will cost the British taxpayer £465,000 by the time they reach 81 years of age. It is clear that opening the ILR door to millions of new migrants will impose a considerable and unwanted financial burden on the British taxpayer for decades to come.
The OBR report explores the opportunity to reform indefinite leave to remain rules, which new clause 25 seeks to do, to help mitigate the long-term fiscal burden of low-skilled migrants, who are unlikely to be net contributors to the public purse. A refusal to back new clause 25 is not just inaction, but a choice to prioritise the untested over taxpayers—to keep the welcome mat out while the costs pile up. The Opposition say no, this is our home, and we expect those arriving to treat it as such.
Pete Wishart
It is a pleasure to once again to serve under you as Chair, Dr Murrison. When I look at the Tory amendments in their totality, they are quite frankly an absolute and utter disgrace. It is as if the Tories have learnt absolutely nothing from the Rwanda debacle and the Illegal Migration Act 2023. Some of the amendments that we will be debating are simply heinous, lacking in any reasonable standard of compassion and empathy. What a country they would create: one devoid of human rights and international protections, where people are simply othered and deprived of any rights whatsoever. Some of the most desperate and wretched people in the world would be denied and booted out.
I used to say that the Tories would never beat Reform in the race to the bottom, but looking at the collection of amendments that we are debating today, they are going to give it their best shot. It is just possible that they will out-Reform Reform colleagues in the House of Commons. The amendments are not only terrifying but ludicrously unworkable—blatant political grandstanding, designed to appeal to the basest of instincts. We have the grim task of having to debate them one by one; I just hope that the Committee will reject them totally out of hand.
New clause 25 was raised in a blaze of publicity at the end of the self-denying ordinance from the Leader of the Opposition when she announced her new immigration policy, which I understand has been changed and finessed over the course of the past few weeks, but is still as grotesque underneath as it started. The Conservatives do not believe that British citizenship should be a privilege; they believe that British citizenship should be virtually unobtainable, and that the strongest possible tests must be applied before anybody is ever going to get the opportunity to call themselves a British citizen. That is totally and utterly self-defeating.
The provision will apply to work-based visa holders, skilled workers and global talent, who can currently apply for ILR after five years. Extending that period to 10 years could deter highly-skilled workers and investors from coming to stay in the UK. It may lead to workforce instability, particularly in sectors reliant on international talent. It would also disadvantage certain migrants and people who have lived legally in the UK for 10 years but do not hold one of the listed visas. This is an unworkable, crazy proposal that can only be self-defeating and have a massive impact on our economy. It would create a massive disincentive to the very people we need to come into the UK to fill some of our skills gaps. I hope the provision is roundly rejected.
Jo White
It is a pleasure to serve under your chairship, Dr Murrison. We should never be surprised by the audacity of the Conservative party, which now exists in a state of amnesia following the previous 14 years of failure, collapse and chaos. Let me take a moment to remind Opposition Members of their failed promises.
A good place to start is the general election campaign of 2010, when David Cameron said that his Government would reduce net migration to the tens of thousands. At that point, net migration stood at 252,000. In 2011, he went further, saying that his target would be achieved by the 2015 general election—“No ifs. No buts.” But when the ballot boxes were opened in that election, numbers had risen to 379,000. Then along came Theresa May. At the snap 2017 general election, net migration stood at 270,000, and she had an election pledge to get net migration down to the tens of thousands, but by 2019 the number had risen to 275,000.
Katie Lam
How can I begin my remarks without repaying the Minister’s kind words about my clothing? This is one of my favourite jackets and I am delighted to see that it might also be one of hers.
It is no secret, as the hon. Member for Bassetlaw has just set out, that previous Governments of different parties have failed the British public on immigration. The level of immigration to this country has been too high for decades and remains so. Every election-winning manifesto since 1974 has promised to reduce migration. As my right hon. Friend the Member for North West Essex (Mrs Badenoch) has said, the last Government, like the Governments before them, promised to do exactly that, but again like the Governments before them, they did not deliver. Because of that failure to deliver, the British public may face a bill of more than £200 billion in the years ahead, unless we change the rules on settlement.
Under current rules, after just five years in the UK, migrants on work or family visas will become eligible for indefinite leave to remain. If they are successful, and 95% of ILR applicants are, they are entitled to welfare, social housing, surcharge-free access to the NHS and more. According to the Centre for Policy Studies, some 800,000 migrants could claim ILR over the course of this Parliament. Given the profile of those who are likely to qualify, that could come at a lifetime cost of £234 billion.
Tom Hayes
Sorry, I coughed and laughed at the same time, partly because I think the hon. Member anticipated the point I was about to make. I will put this on the record again, as I have consistently. She may have more information to come back to me with and I will come back to her. The Centre for Policy Studies report is flawed. It has skewed information; it uses assumptions that are unreasonable and the financial modelling that ensues is therefore unreasonable. As a consequence, it feels like the Centre for Policy Studies and the hon. Member are reaching for a very large number to create the impression that there will be a very significant financial burden.
I make two additional points. First, even if that report relied on reasonable assumptions and therefore the modelling was correct, the Boris wave was caused by her party’s Government. She is nodding her head; she affirms that. I welcome that, in her speech, she has so far acknowledged the failings of that Government. Secondly, the report makes some very big assumptions about the future behaviour of the people currently in the migration system in our country. That is not a wise move, particularly when she is extrapolating £235 billion to £240 billion across a very long timeline. In fact, if we were to break it down on an annualised basis, even using the report’s flawed assumptions and flawed modelling, the figure would be far smaller. We need to have some integrity in the data that we use. Does she agree?
Katie Lam
As Professor Brian Bell said in evidence to this Committee—in a session to which the hon. Member for Bournemouth East has referred a couple of times—
“It is actually extremely difficult to work out the fiscal impact of migration.”––[Official Report, Border Security, Asylum and Immigration Public Bill Committee, 27 February 2025; c. 59, Q92.]
That is clearly true: forecasting the lives of millions of people over decades will obviously have a substantial margin for error.
The only way to avoid that error would be not to try to forecast in the first place. I have repeatedly asked the Home Office, over several months, whether anyone in that Department or any other—indeed, anyone in Government—is attempting to forecast the cost to the public purse of the ILR grants that will come in this Parliament. I am yet to receive an answer. To me, that clearly says that nobody in Government is thinking about the impact the issue will have and how much it will cost. When they do, I will happily use those numbers. Until and unless that happens, the modelling from the CPS is the best we have—in fact, it is all that we have.
Tom Hayes
This is my last intervention on this matter. I take the hon. Lady’s point entirely, but will she not acknowledge that the modelling has deep, fundamental flaws? Although it may be the only modelling and therefore the best, on the strength of what is in that report it is still not worth considering or using in parliamentary debate.
Katie Lam
I have already acknowledged that the margin for error is massive—that is clearly true. If everything that the hon. Member is saying is correct, I would like to see Government figures to replace the CPS figures. I think that is a reasonable request.
The £234 billion cost is equivalent to £8,200 per household, or around six times our annual defence budget, and this about not just money but capacity. Our public services are clearly already overstretched and this could push them to breaking point. If we accept, as we should, that previous Governments have failed on migration, then we should do everything in our power to limit the long-term impacts of that failure. That is why the Conservatives propose to extend the qualifying period for ILR and reform settlement rules to ensure that only those genuinely likely to contribute will be eligible for long-term settlement. That would give us an opportunity to review visas issued over the last few years. Those who have come to this country legally on time-limited visas and have subsequently not contributed enough, or have damaged our society by committing crime, should be expected to leave.
The Prime Minister has repeatedly said that the levels of immigration under the last Government were wrong and that it was a mistake to allow so many people to come to the UK. This amendment would allow the Government to limit the long-term consequences of that mistake, so why would they oppose it? It is not too late to change our rules around settlement. By refusing to extend the eligibility period for indefinite leave to remain, the Government are actively choosing to saddle the British taxpayer with a likely bill of hundreds of billions of pounds. We must make difficult decisions on this reform and the many others required in our migration system. Those decisions may be painful, especially in the short term, for individual people, families or businesses but they are the only way for any Government’s actions to match their words. The public have had enough and rightly so.
The hon. Member for Bournemouth East talked about LLR, which must be applied for every two and a half years on the existing 10-year route. That is the case only because, as it stands, the 10-year route, by design, is for those not on eligible visas. The five-year route that we here propose to change is exclusively for those on eligible visas. I therefore cannot see why, within the existing rules, there would be any requirement for LLR applications. I hope that reassures the hon. Member.
Margaret Mullane
The new clause is not in keeping with the provisions outlined in the Bill, which primarily focus on border security through new and strengthened law enforcement powers, providing intelligence to address organised immigration crime.
I fundamentally disagree with the context of the new clause. Subsection (2) relates to existing legislation whereby the qualification of indefinite leave to remain applies to people on skilled work visas, scale-up worker visas, entrepreneurial or investor visas, innovation founder visas, or UK ancestry visas, and people with a partner who holds citizenship. Those people are, for the most part, contributing to our society through work. If somebody has been living and working here in a skilled role, or innovating in our country—and possibly even supporting job creation—for five years, that is long enough for them to identify Britain as their home. They will have friends and community networks. In most instances, they are boosting our economic productivity. The increased qualification period set out in the proposed new clause would move the goalposts for skilled workers after years of contribution.
I will bring the conversation back to the purpose of the Bill: the Committee’s focus should be on those entering the UK illegally and those engaged in organised immigration crime, not the construction workers, nurses, doctors, investors and business owners in Britain on work visas.
Tom Hayes
I will speak briefly. I welcome the hon. Member for Weald of Kent’s clarification of the Conservative party’s position on the amendment, but that clarification also raises further questions; I wonder whether the hon. Lady could respond on the spot. If there is no requirement every 30 months in the 10-year period for an individual to pay fees of £2,608—or, for a child, £2,223—to the Home Office, how will the Home Office fund much of its work? The fees paid by adults and children contribute significantly to the Home Office’s budget. The point is particularly important because the Home Office has had to borrow from the official development assistance budget in order to fund asylum hotels. I worry that there is going to be a significant financial gap here, and I wonder if the hon. Lady could clarify what her costings are?
Katie Lam
I think the hon. Gentleman is eliding two different routes. At the moment there is a five-year route, which is for people on eligible visas, and a 10-year route. The 10-year route has LLR requirements that have to be applied for every two and a half years, and is the route that generates the fees that he is talking about. Under the amendment, that would not change; we are proposing changes only to the five-year route. The five-year route at the moment does not have LLR requirements because it is for people on eligible visas. The income for the Home Office from the same people should be no different under the amendment that we are proposing. I hope that that is clear.
Tom Hayes
I am happy to accept that clarification. If that is correct, I look forward to seeing more information about the particular policy, what financial costs would be involved and what the financial benefits would be.
Finally, I echo the point made by my hon. Friend the Member for Edinburgh East and Musselburgh about the importance of settling. We talk here about the financial costs: it is going to be more costly to our country and public services if somebody is having to go through many years of unsettled status. It is going to be harder for them to have all the infrastructure and anchors that they need within society. As a consequence, I would love to know whether the Conservatives have done any modelling of the impact of increasing the period of limbo, including—as mentioned in the IPPR report that I referenced earlier—the cost to public services when people find themselves homeless, with difficult mental health conditions or unable to take their child to the school that they want and have to travel significant mileage.
The hon. Lady and I share a desire for the integrity of data and its greater availability. In proposing the amendment, does she have access to any of that information?
Katie Lam
He is nodding.
Part of what we are trying to say by extending the time is that we feel that a person’s commitment to the UK before they apply for settlement should be longer than five years. If application numbers go down because people feel that they do not want to commit for 10 years before getting settlement, that is something that we are happy to accept as part of the amendment.
It seems from the numbers that we have at the moment that the number of people who would apply over an extended period would go down because fewer people would qualify under the rules that we are stipulating. The reason why they would not qualify is that they would not be making a sufficiently significant contribution to the public purse over that period. Our calculations are that all of those lost applications would be net fiscally positive.
Tom Hayes
In which case, I will close by saying that the Home Office data shows there is not that drop-off of people—people do not leave the country because they have to wait longer for their status. In fact, those people try to get that status by serving within our country and economy. The Home Office data, which is publicly available on gov.uk, records what the stay and departure rates are each year. I am not sure that the amendment and the policy within it are going to achieve the goal that the hon. Lady is seeking.
Katie Lam
I totally take the hon. Gentleman’s point, but I think he is answering a slightly different point. What we are saying is that the combination of the extension of time and the change in criteria would lead to lower applications. It is not so much about a choice on the part of the individual migrant, but a structural change within the system.
Tom Hayes
The very last point I will make is that I understand what the hon. Lady is saying, but that is not what my point was about. This would not be a deterrent or an incentive for people to leave the country. People would still remain in the country. The health impacts and the limbo that people would experience through their inability to settle would still create a fiscal drag.
The Parliamentary Under-Secretary of State for the Home Department (Seema Malhotra)
It is a pleasure to serve under your chairship, Dr Murrison, and to make a few remarks at the end of this interesting debate. I will make a few general comments first and then make more detailed comments on new clause 25.
It is worth re-stating some of the shadow Minister’s points. He said that, for too long, we have had an open-door policy that is open to abuse. He also said that we should remember that we are in government. He is absolutely right that the Tories lost control over our immigration system. We do not need reminding of that—nor do we need reminding that we are in government clearing up their mess.
The context for a lot of the debate today has been the massive backlogs that have built up in every part of the system, the failure to have controls over our system, the levels of abuse and the fall in returns for those who have no right to be here. It is worth mentioning that the steady increase in settlement grants in 2017 reflects high levels of migration in previous years. It is almost as if the Tories are attempting to close the gates to the field from which the horses have long bolted, and everyone else is now picking up the pieces.
It is worth correcting the impression that the shadow Minister gives about our policy. We agree that settlement in the UK is a privilege; it is not an automatic entitlement. However, we understand that the immigration system needs to account for people in a range of circumstances beyond those specified in new clause 25. We also recognise and value the contribution that legal migration makes to our country and believe that the immigration system needs to be much better controlled and managed.
Provisions for settlement are set out in the immigration rules, so the Bill is not the correct legislation for debate about requirements for settlement. What we are doing with this Bill is strengthening our borders, going after the criminal smuggling gangs that have caused so much damage to the lives of migrants already and put lives at risk daily, and securing our borders against systemic abuse.
New clause 25 would restrict settlement in the UK to a handful of economic routes and partners of British citizens. Other routes to settlement in the current immigration system would therefore be excluded from settlement should the new clause be accepted, including settlement for refugees. The shadow Minister may have a view about, for example, a situation facing an Afghan interpreter for the British armed forces who put their life at risk, was evacuated to the UK after the chaos in Kabul in 2020 and was then put up in taxpayer-funded accommodation after arrival in the UK. Correct me if I am wrong, but under clause 25 they would be banned from ever settling in the UK.
It is important that we understand that settlement in the UK is privilege, the argument for which was rightly made. It is right because settlement conveys significant benefits, including the right to live here permanently and to access work, study and public funds, as well as a pathway to citizenship. We also have rules and processes to recognise the expectation that people should serve a period with temporary permission before being eligible to apply for settlement.
There is a range of periods of time that people need to spend in the UK before they can qualify for settlement. Many are five years, but there are shorter periods for exceptional routes. The hon. Member for Stockton West did not lay out his view on some of those specialised routes that may offer a shorter path to settlement, such as the global talent route or the innovator founder route. They allow settlement within three years to help the UK to attract the best talent from around the world, and they reward those working in business who are making some of the greatest economic contributions.
While I want to quote from the Centre for Policy Studies and the Adam Smith Institute, as they are the most important references in these debates, the new clause does not really think through the immigration system as a whole. We must think about it being fairer, more controlled and managed, and we must ensure that it recovers from the chaos that the last Government left it in. Indeed, as the hon. Member for Stockton West will know, the Government will also set out our approach to immigration, including how we bring net migration down and how we link skills policy with visa policy, so that we reduce our dependence on recruiting from overseas. We will be setting out that coherent approach to a future immigration system in a White Paper that is coming out later this spring.
Matt Vickers
I am stunned—shocked. In fact, I cannot believe that the SNP is less than enthusiastic about our new clause. The Minister and the hon. Member for Bassetlaw were keen to talk about records, but at the risk of repeating myself, immigration is too high. Previous Governments have failed to solve it. I would love for the Government to succeed in doing so, but I am not convinced that they will, particularly without a robust deterrent. I say it again: since this Government were elected, the number of people arriving here illegally is up 28%, and the number of people in hotels is up 29%. There are 8,500 more people in hotels in communities across the country, and fewer of those people who arrive by small boat are being returned.
Seema Malhotra
Does the shadow Minister also agree that, since we came into government to the end of January, returns were almost 19,000, which is up around a fifth on what they were 12 years before, including an increase of about a quarter on enforced returns? He may want to talk more about that.
Matt Vickers
I am sure the Minister will agree that a large part of those are voluntary returns. I am sure a large part of them may also benefit from some of the agreements made by the previous Government. Actually, when we talk about the people arriving here illegally on small boats, the number is up significantly in the last two quarters, since this Government came into office. That is a fact.
Tom Hayes
I am reading from the Home Office website, which says:
“Comparisons of arrivals between the same months in different years may also be affected by differences in conditions. As a result, we do not make comparisons between shorter periods where arrival numbers…may fluctuate considerably.”
The Home Office also comments:
“Financial, social, physical and geographical factors may influence the method of entry individuals use and the types of individuals detected arriving… These factors may also change over time.”
Therefore, is it not the case that looking at just two quarters, and trying to make a comparison, is not really the most robust way of doing this? Is it not better to reflect on the Bill and the changes it is seeking to introduce, and to realise that it will make a significant difference in the medium to long term?
Matt Vickers
Two quarters is a significant amount of time. This is a record. The hon. Gentleman might not be comfortable with it, but the number of people who have arrived here illegally being returned is going down significantly. It is a fact, and this new clause matters. More than 742,000 people will qualify for indefinite leave to remain in the next couple of years. As we have said, that could cost our constituents £8,200 per household. That is a significant cost to people in my part of the world. Because of that cost to my constituents, I would like to press the new clause to a Division.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss
New clause 43—Age determination by the Home Office—
“(1) A person who claims to be a child must not be treated as an adult by the Home Office for the purpose of immigration control.
(2) Subsection (1) does not apply where—
(a) the Secretary of State has determined that the circumstances are exceptional, or
(b) a local authority has determined that the person is an adult following a Merton-compliant age assessment.
(3) An age assessment must be undertaken by a social worker who has undertaken training on the conduct of age assessments.
(4) The Home Office must retain a record of the methodology and outcome for each age assessment undertaken for the purpose of immigration control.
(5) The Secretary of State must, through regulations made by statutory instrument, establish a framework for independent oversight of the conduct of age assessments.
(6) A statutory instrument containing regulations under this Act may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.
(7) Where a person claiming to be a child is determined by the Home Office to be an adult and is placed in adult accommodation or detention, the Home Office must notify the relevant local authority as soon as possible.”
This new clause would ensure individuals claiming to be children are not treated as adults, except in exceptional circumstances or following a Merton-compliant age assessment. It would provide independent oversight of the age assessment process, and notification to local authorities when a person is placed in adult accommodation or detention.
Matt Vickers
The Bill repeals sections 57 and 58 of the Illegal Migration Act, which concern scientific age assessment methods. The Conservative party completely disagree with that decision. Every European country apart from ours uses scientific age assessment techniques such as an x-ray of the wrist, although there are other methods. More than 50% of those claiming to be children were found to be adults after an age assessment in the quarter before the election. Without a scientific age assessment method, it is very hard to determine their age. There have been cases of men in their mid-20s ending up in schools with teenage girls, and that carries obvious safeguarding risks. We have tabled the new clause to ensure that scientific methods for assessing a person’s age are used, and to disapply the requirement for consent for these methods to be used.
Matt Vickers
We have said that there are several methods. If we are unhappy with one, we can use alternatives. This is something that British taxpayers want to see. They want to ensure that our classrooms and social care settings are safe.
Matt Vickers
There are a raft of methods. I am happy to be directed, but every country in the EU uses the method I have mentioned. It is tried and tested. It is easy to criticise, question and find holes in a plethora of methods, but I think this is the right thing to do.
Matt Vickers
We can debate the methods at length, I am sure, but I think we have a responsibility to have a method. The fact that the rest of Europe is doing it means it is something we should be doing.
Tom Hayes
The rest of Europe is doing free trade, but the shadow Minister does not want to do that. We should reflect on Europe and what we want to import into our country.
On the bone age assessment, can the hon. Gentleman tell us with confidence grounded in science that it would be able to determine the range of relevant ages? Can he tell me what the margin of error would be for someone aged 18 or 19, and what an assessment of bone density and bone age would tell us if they posed as 15 or 16?
Matt Vickers
I can tell the hon. Gentleman that these age assessments could go some way to ensuring that a 20 or 30-year-old does not end up in a classroom beside a teenage girl. There is an opportunity to provide a power that can be used, along with all the knowledge that the agencies have, to make an assessment. The science can be determined, and the agencies can look at it in the round. We know that people have turned up without any form of identification. This is an opportunity to draw a line in the sand. Where agencies think this is the right thing to do, they can use the power. Of course, they will use it in moderation and in the context of the question marks around any method that they would use to assess age.
Matt Vickers
I would trust our agencies to use them in context and apply all the other things that they might apply in any given context. This would be another tool that agencies could use, on top of all the knowledge that they might have of people coming in and what their ages might be. This is an opportunity to give our agencies another tool, and it is the right thing to do.
That is why we tabled new clause 26, which would ensure that scientific methods for assessing a person’s age are used, while disapplying the requirement for consent for these methods to be used. That would ensure that adults could not claim to be children. It also gives the Government an opportunity to undo the mistake of repealing the relevant sections of the Illegal Migration Act and allow age assessments for those claiming to be children.
Becky Gittins (Clwyd East) (Lab)
It is a privilege to serve under your chairpersonship, Dr Murrison. Given that the hon. Gentleman’s concern is about children, we should recall the evidence session in which we heard the Children’s Commissioner’s concern that spending extended periods of time in asylum hotels leaves unaccompanied asylum-seeking children vulnerable to organised crime, notwithstanding the mix of ages in those hotels. Why does he still stand by the Illegal Migration Act and the Safety of Rwanda (Asylum and Immigration) Act 2024, when they are part of the reason why those children were in asylum hotels for so long?
Matt Vickers
I will stick to the new clause and the age assessments. This is a tool. It would not be used unabated. It is another tool that our agencies could use alongside whatever other assessments they might make. We would be giving them the opportunity to require people to undergo an assessment, and that is a good thing. That is why the rest of Europe is doing it. The agencies and experts—the professionals on the frontline dealing with these very troubling, difficult cases—should have all the tools they could possibly require to handle them. I see no reason why we would prevent them from doing so.
Tom Hayes
I appreciate the hon. Gentleman’s desire for our frontline staff to have all the tools they need. The Bill will expand the number of tools, but those are the tools that frontline staff are requesting. We could have scientific age assessments, and the Government are certainly not ruling them out entirely; there is work going on in the Home Office to consider their efficacy. Does he agree that we need tools that will help our frontline staff achieve the goals that we set them? The Royal College of Paediatrics and Child Health says that age determination is an inexact science, and that the margin of error can sometimes be as much as five years either side. I myself am not a scientist or a member of the royal college—I assume that the same is true of the hon. Member—so is it not better that we listen to such expert bodies, and develop policy in line with them, rather than just saying, “Because Europe is doing it, we ought to do it”?
Matt Vickers
That is a safe assessment of my scientific qualifications.
We are not saying that this is the only thing that agencies and experts on the frontline, who deal with these cases day in and day out, will be able to use; it is something that they can use. If we have ended up with adults in classrooms alongside children, that is wrong. We need to give the agencies every tool in the armoury to make the situation work. This is one thing that they can use—with their knowledge and with every other assessment they would make—and it is the right thing to do.
We have talked about kicking this down the road. I think we have a commitment that the Government will do something on this issue some day, or some time. But here is an opportunity to keep the power in the legislation for agencies to use here and now, rather than in six months or a year. I am sure that the Minister will give me a timeframe on whether the Government will come back with such a power.
The SNP’s new clause 43 is almost the polar opposite of our new clause. It states:
“A person who claims to be a child must not be treated as an adult by the Home Office for the purpose of immigration control.”
We know that there are adults coming to this country who claim to be children. Believing them without question would make it harder to control our borders and create significant safeguarding concerns. Why does the SNP think it should be made harder for the Government to determine the true age of those entering this country illegally? How does this best serve the interests of the British people? Given the SNP’s blind adoration for the European Union, we must question why they are happy for the United Kingdom, of which Scotland is a key part, to be the only European nation that does not use medical tests to determine the age of those coming to the country.
Why does this matter? The issue has not decreased in significance. The number of asylum age disputes remains high, particularly in the latest available figures. Of those about whom a dispute was raised and resolved, more than half were found to be over the age of 18. The fact that a record number of asylum seekers pretend to be children should be the wake-up call that we need to ensure that we have the checks in place to verify age and stop those who seek to deceive from entering the UK. As the available figures show, this tactic is becoming commonplace, and action must be taken to stop this abhorrent abuse.
If the figures were not evidence of the need to support new clause 26, perhaps the facts of the cases will be. A 22-year-old Afghan who had murdered two people in Serbia claimed asylum in the UK by pretending to be a 14-year-old orphan, when in fact he was 18. There is the utterly horrific case of the Parsons Green terrorist, Ahmed Hassan, who posed as a 16-year-old before setting off a bomb on a tube train in west London, injuring 23 people. Although the Iraqi’s real age remains unknown, the judge who jailed him for 34 years in 2018 said he was satisfied that the bomber was between 18 and 21. The clock is ticking. The crisis is not slowing; it is surging.
In quarter 2 of 2024 alone, 2,088 age disputes landed on the desk of the Home Office. That is 2,088 claims where someone said, “Trust me, I’m a child.” By the end, 757 were unmasked as adults, and the deception rate was a staggering 52%. That is not a blip, but a blazing red flag. That is more than 750 grown men, and potentially dozens more uncaught, slipping through a system that Labour has crippled by repealing the scientific age checks in the Illegal Migration Act, leaving us guessing in the dark while the numbers climb.
Dame Angela Eagle
I will deal with some of the broader points in my response, but we do age assessments. We do not simply accept—just as his Government did not—asylum seekers’ claims about their age as if they were the truth. I would not like the shadow Minister to give the Committee the impression that that is happening—that we are accepting claimed ages without any kind of check. I will go into much more detail in my response to the debate about precisely what we do, but he must not give the impression that we are not checking; we are.
Matt Vickers
I hope the Minister agrees that we should be doing more, rather than less. We need to give agencies all the opportunities and powers to do so, with or without the consent of people who aim to deceive. That is the right thing to do.
If we rewind to 2022, 490 disputes in quarter 1 ballooned to 1,782 by quarter 4. Now we are at 2,088 and counting. This is not a fading headache; it is an escalating emergency. It is a conveyor belt of fraud clogging our borders and spilling into our schools. Failure to conduct these vital checks would mean that we are not just blind, but complicit in handing traffickers a playbook that says, “Send adults, call them kids and watch us flounder.” The public sees it and parents feel it, and every day we delay, the risk festers. We need science, not sentiment, and we need it now.
Pete Wishart
I rise to speak to new clause 43 on age determination by the Home Office. The one thing we can agree on with the Conservative Front Benchers is that my new clause could not be more different in objective and tone than what we have heard from the shadow Minister. My new clause aims to uphold a simple yet vital principle that no child should be wrongly treated as an adult, subjected to detention or placed in inappropriate accommodation, as happens right now. The new clause would ensure that the Home Office treats as an adult an individual who claims to be a child only in exceptional circumstances or following a Merton-compliant age assessment conducted by local authority social workers. Furthermore, any decision to treat a young person as an adult would have to be made by an appropriately trained official, with reasons recorded and subject to independent oversight. Where such a decision results in the person being placed in adult accommodation or detention, the relevant local authority would have to be notified immediately.
Labour Members are right to have a go at the shadow Minister, but it is imperative that we get this right. This is life-determining and life-shaping for the individuals at the sharp end of these age assessments. The consequences of flawed age assessments at our borders are severe.
Recent data reveals that between January and June 2024 alone, at least 262 children were wrongly assessed as adults and placed in adult accommodation or detention, exposing them to significant safeguarding risks including exploitation, violence and even criminal prosecution. It is worth noting that in many cases, those children endure months of uncertainty before being correctly identified and moved into appropriate care settings. Such errors not only violate child protection principles but undermine the credibility of our asylum system.
The current process of visual assessment, often conducted at the border by immigration officers, is wholly inadequate. Assessments based solely on appearance and demeanour are inherently flawed and have led to serious misjudgments. International and domestic guidance is clear that age assessments should be undertaken only when necessary and should be conducted using holistic, multidisciplinary approaches, yet that is far from the reality.
Concerns about visual assessments have been raised not just by non-governmental organisations, but by the independent chief inspector of borders and immigration, the Children’s Commissioner, parliamentary Committees and the UN Committee on the Rights of the Child. In response to those great concerns, the Government have argued that they are improving the age assessment process through the national age assessment board, and by introducing scientific methods of assessing age—we are back to that debate again. It is important to note that neither of those initiatives has any impact on visual assessments made by officials at the border. Biological methods such as dental X-rays and bone age assessment remain highly unreliable, as medical and scientific bodies repeatedly state. I listened to the hon. Member for Stockton West make great play of saying that that is what all of Europe does, but there are countless cases that the EU and other European nations have got wrong. I can send them to him; he can spend most of the day looking at them. They get cases wrong, just as we do with visual assessments.
It is right that in this Bill the Government seek to repeal clause 58 of the Illegal Migration Act, which would have meant that children who refuse to undergo these invasive and questionable procedures are presumed to be adults by default—an approach that runs contrary to any safeguarding principles. The previous Government attempted to justify that policy by highlighting the risk of adults falsely claiming to be children to access benefits and services designed for minors. However, the reality is that the greater danger lies in the wrongful treatment of children as adults, which places them in unsafe environments, denies them their rights and can have devastating long-term consequences. The number of children found to have been misclassified as adults outweighs the number of cases where an adult has falsely claimed to be a child, so we have the balance totally wrong.
Crucially, there are greater risks and consequences to placing a child among adults, where there are no safeguards in place, than to placing a young adult in local authority care. It is essential that we restore local authority-led age assessments as a primary mechanism for resolving age disputes. As child protection professionals, local authority social workers are best placed to conduct those assessments in a manner that is thorough, fair and in the child’s best interests. The new clause would ensure that young people who assert that they are children are treated as such unless and until a proper assessment proves otherwise. It also guarantees transparency, independent oversight and accountability in decision making, thereby restoring trust in the system.
Katie Lam
On 23 January 2023, Lawangeen Abdulrahimzai was sentenced to life imprisonment at Salisbury Crown court. Nearly a year earlier, Abdulrahimzai had murdered 21-year-old Thomas Roberts in Bournemouth town centre by stabbing him to death in the street following a dispute over an e-scooter.
Abdulrahimzai was an Afghan asylum seeker who came to this country in December 2019. He entered the UK illegally, claiming to be an unaccompanied 14-year-old. He was placed in school and in foster care, but he was in fact already an adult when he came here. Not only was he an adult, but he was also a murderer, having killed two men in Serbia before coming to the UK. He should never have been allowed to come to this country and he should certainly not have been allowed to masquerade as a child.
Assessing a person’s age is surprisingly difficult, but we have a range of tools to do so—the Home Office is just not using them. If we had acted sooner, using the full suite of tools at our disposal to assess Abdulrahimzai’s age, Thomas Roberts might still be alive today. The case of Lawangeen Abdulrahimzai is particularly shocking, but it is unfortunately far from unique.
Chris Murray
I wonder whether there have been any new scientific discoveries in the last seven months for identifying someone’s age that the Home Office would not have been aware of over the last 14 years. Is it not the case that the methodologies used are very imprecise and do not often actually lead us, in the liminal cases, to draw the distinction that the hon. Lady is advocating for?
Katie Lam
I will come on to precision and the ways of determining age slightly later in my remarks.
Ahmed Hassan, an Iraqi asylum seeker, claimed to be a 16-year-old when he arrived in the UK. In 2017, he set off a bomb at Parsons Green tube station, injuring 23 people. His real age is still not a matter of public record. In 2018, a Home Office probe found that Siavash Shah, an Iranian asylum seeker, spent six weeks as a year 11 pupil in Ipswich despite being 25—the list goes on. In fact, between 2020 and 2023, the Home Office identified almost 4,000 cases of adult migrants claiming to be children—45% of those who originally claimed to be children when they arrived here—and every other person of that cohort was in fact an adult. Some were at least 30 years old. That puts British children at risk, puts genuine child asylum seekers at risk and takes valuable school and care places away from the young people who genuinely need them.
I feel this particularly keenly as a Member of Parliament for Kent, the county into which all small boats arrive. Our laws mandate that the people who come to this country illegally and claim to be under 18 must be prioritised for care equally with Kentish children. That puts enormous pressure on the system and makes it harder for our children to be cared for. That is madness when we know that half of those arrivals are in fact adults, and we must put a stop to it.
It is completely rational, albeit morally wrong, for adult migrants to claim to be children. Under-18s who come here have a greater entitlement to care and support, do not have to live in accommodation with adults, and are not subject to the same rules as adults—or the rules are applied less strictly. Of course, there are people who cross the channel without their parents who are under 18; most, though not all, are male 17 and 16-year-olds, and some are younger children. No one disputes that, and children should be treated as children, but we must be realistic about the scandalous degree to which our system is exploited by the cynical and the sinister.
We have to protect actual children, and we should use every tool in the box to do so, including scientific testing. Where people refuse such tests, the Government should be able to override that refusal. We are acting in the interests of public safety and to protect the security of our children. Labour Members have asked for exact details of the scientific methods. As my hon. Friend the Member for Stockton West set out, there are many methods and several different ways of doing it. The ones that can be implemented in short order are the dental and skeletal tests.
Other methods are currently at an earlier stage of development, such as facial age estimation and DNA methylation, which is a process by which people much cleverer than me can assess how a person’s genes are read by their body, which changes with age. In 2022, the interim Age Estimation Science Advisory Committee stated that the
“teeth, clavicle, and hand/wrist or knee… have been shown to have a significant research and publication credibility and provide a consistent age range over which changes occur.”
Later, the same report states:
“The committee has relied on areas and methods that have been repeatedly tried and tested and shown to have consistency.”
As the report makes clear, and as Government Members have said, scientific age assessment is not perfectly precise and is not magic, but as my hon. Friend the Member for Stockton West also correctly says, our proposal is that scientific age assessments should be used not to replace other methods and judgments, but to supplement them.
The situations that my hon. Friend and I have set out are horrifying. We can see no reason why the Government would not want to have the widest possible set of tools available to them to stop such things happening, including the option in future to bring in scientific methods that are currently at a nascent stage.
Tom Hayes
I thank the hon. Member for Weald of Kent for raising the absolutely horrific and awful circumstances involving Thomas Roberts, who would have been my constituent and whose mother, Dolores, is my constituent. She is racked by grief and unable to sleep at night. Her health has worsened because, as she said to the Minister and me last night in the Minister’s office, with her son being murdered, she feels that half of her whole life has completely disappeared.
I do not want to name the murderer in this debate; I name Thomas Roberts, the victim. I want to talk briefly, with your permission, Dr Murrison, about Thomas Roberts, because it is important for the Committee to know who he was. It is important for Dolores, so racked with grief, to know that her MP and the Committee are focused on what happened.
Thomas was 21 years of age when he died on 12 March 2022 in Bournemouth town centre, the victim of a stabbing by an asylum seeker. His mum has told me several times, and she told me again with the Minister last night, that Thomas was known by everyone and, when his mother wanted to go into town, to Littledown or to other parts of the constituency, he would say no, because he was so well known and he did not want to be seen by his friends out with his mum.
Thomas was an aspiring Royal Marine and, in order to become one, he was in the Sea Scouts. He was physically fit—so fit, in fact, that he would actually bench press his mum and his brother. Dolores told me that the passing of his driving test on the first go was one of her proudest moments. It is one of the things that she remembers so fondly and so closely now, as she comes to terms with her grief.
Thomas was also an aspiring drum and bass DJ, and by all accounts a very good one, who was up and coming on the south coast. If he had not made it as a Royal Marine—there was every certainty that he would—he could easily have taken up a drum and bass DJ career. He was a member of the Christchurch boxing club. He was active in his community, and deeply loving and caring about his family.
Thomas lost his life—or rather, his life was taken from him—because an asylum seeker was in our country. That begs the question: why was that person in our country? Why were they able to wield the knife that cut short Thomas Roberts’s life, and that took away all the hopes and ambitions that his mother had for him? It is because we did not have access to the necessary database to track criminality and find out more about who the asylum seeker actually was. I am deeply sad that Thomas is not with his mum, in his community, or with his friends who loved him so much, because the last Government broke our asylum and immigration system, and created the conditions for that tragic killing and other tragic killings that have happened in our country.
Scientific age assessment, as the hon. Member for Weald of Kent said, is not a magic wand; it is imprecise, as we heard from the Royal College of Paediatrics and Child Health. We know what works, and that having a functioning asylum and immigration system will make all the difference. I just wish we had had that on 12 March 2022 when Thomas was denied his life opportunities because of the breakages in that system.
I thank the Minister for meeting Dolores yesterday—I know that that provided her with much-needed comfort and clarity. I am absolutely confident that the Bill and its measures will make the difference that is so needed to protect our society. I also note the contribution of Councillor Joe Salmon of Bournemouth, Christchurch and Poole council, who has been such a support to Dolores and her wider community, because she will be grieving for a very long time. It is incumbent on all of us in public service to speak the truth, look at the facts and bring forward the measures that will make the biggest difference.
If I may, I will return to the question of scientific age assessments. I referred to the concerns of the Royal College of Paediatrics and Child Health and of experts, but I now refer to the House of Lords debate on 27 November 2023, which is worth a read if Opposition Members have not had a chance. It goes into significant detail and depth about the concerns that I had about that as a possible policy at that stage of its development.
The Minister has been clear that scientific age assessments are not off the table; there just needs to be certainty that they are an effective tool. To avoid any further deaths and injustices, we need to have the right tools to protect the people of this country, secure and protect our borders, and make sure that we are truly able to restore confidence and trust in this system and in our ability to manage who comes into our country and who stays here.
Becky Gittins
I thank my hon. Friend the Member for Bournemouth East and the hon. Member for Weald of Kent for playing a respectful part in quite a heated discussion, which has done honour to Dolores and her family at an incredibly difficult time. It is really poignant that such case studies are discussed in these debates; they show what can happen on the limited and rare occasions that things go incredibly wrong with such systems. It is worthwhile that we have these discussions.
I must say that I was disappointed by Opposition Members’ contributions in support of the new clause, however, because although they successfully focused on occasions where things have gone wrong, they were limited on detail. I was also disappointed by their inability to answer the question of my hon. Friend the Member for Edinburgh East and Musselburgh. We need that detail, and we need to understand how that would be different from the tools in the Home Office’s arsenal during the 14 years of their Government.
Katie Lam
It was a privilege to hear about Thomas Roberts’s life. The hon. Member for Bournemouth East did himself great credit in telling us about him so movingly. Thomas’s mother, Dolores, whose pain is impossible for us to imagine, has also done his memory great credit by finding a way in her grief to talk about her son to her Member of Parliament and to the Minister.
Securing the border is a genuinely difficult job, and the Opposition are genuine in our desire to support the Government in doing that. We really believe that the new clause would help the Government to expand their ability to do that job. We deeply hope that they will consider it. I also thank the hon. Member for Clwyd East for her generous words.
Dame Angela Eagle
I start by endorsing what my hon. Friend the Member for Bournemouth East said about Dolores, Thomas Roberts’s mum, whom I met last night. She has gone through a searingly awful life experience. It is difficult even to think about that, let alone to offer any comfort. Unfortunately, I do not think that her experience would have changed much had scientific age assessment been in place, although the person in question had been assessed by his local authority as a child and was therefore in a separate environment from that which he would have been in had he not been assessed.
I am determined to see whether we can connect up our information about people coming from Europe, following Brexit and the disintegration of our access to Eurodac and various other pieces of information collected in Europe on asylum seekers and those arriving illegally—not all of them are asylum seekers. Reconnecting, if possible, to those databases would give us more comfort than we have at the moment. However, I emphasise that when people come to this country, we do check them against all our biometric records and the terrorism lists and watch lists that we have. It may be possible for us to do more in future.
We have had a debate about new clause 26 from the Opposition and new clause 43 from the hon. Member for Perth and Kinross-shire on behalf of the Scottish National party. That has again demonstrated the wide range of opinion that there is at both ends of the argument whenever we consider such issues. I will deal with both arguments in my response, and I hope to find a middle way.
First, repealing section 58 of the Illegal Migration Act, which the Bill seeks to do, does not stop our capacity to do age assessments. Listening to some of the contributions from members of the official Opposition, one would have thought that repealing section 58 will take off the table—completely and utterly—all age assessment. That is simply not true. The age assessments in section 58 were about the duty to remove somebody to Rwanda; they were not connected to anything else. As I understand it, the issue with that legislation was that the then Government’s intention was not to remove children to Rwanda, so it became more important to have a way of assessing whether somebody was a child. The Safety of Rwanda Act and the IMA—the previous Government’s approach to this issue—would have created even bigger incentives for people to claim that that they were children, because they would have avoided being sent to Rwanda, not that anyone ever actually ended up there. The previous Government’s approach of deportation permanently to Rwanda actually created even more incentives for people to lie about their age.
The fact is that there are people who are genuine asylum seekers who are children, people who are not genuine asylum seekers who are adults who claim to be children, and children who sometimes claim that they are adults. When that happens, one has to look at modern slavery issues and coercive control. There are safeguarding issues on both sides of the age assessment argument. Children pretend to be adults for reasons that we can imagine, but we will not go into those, because they are not very pleasant. There are also incentives created by the way in which the Children Act 1989 deals with unaccompanied asylum-seeking children. As a Kent MP, the hon. Member for Weald of Kent knows exactly what happens with the Kent intake unit and the pressure that her own local authority has been put under. However, she also knows about the Government support that her local authority has been given to disperse unaccompanied asylum-seeking children around the rest of the country so that some of the burden can be shared.
We are dealing with people who arrive without papers. Some of them wish to lie about their age, and some have been told to lie because the people-smuggling gangs perceive it as a way for people to access more resources than they could if they were seen as adults. As the hon. Member for Perth and Kinross-shire pointed out, the system can get it wrong on both sides. People who are children have been judged to be adults and put in inappropriate places, and people who are adults have been judged to be children and put in appropriate places. There is no guaranteed scientific way of making a judgment. We can make judgments about people who are much older, but we are dealing with that uncertain four to five-year range on either side, which is the difference between 18 and 24 or 17 and 23; you will know about that, Dr Murrison, from your work as a medical doctor.
On new clause 26, I want to reassure Opposition Members that there is already provision in law for the use of age assessment, and our repealing of section 58 of the Illegal Migration Act does not remove that provision. That is because the Immigration (Age Assessments) Regulations 2024, which followed scientific advice from the Age Estimation Science Advisory Committee in the Home Office, specify for the purposes of section 52 of the Nationality and Borders Act 2022 the scientific methods currently recommended for age assessment. We have retained those bits of legislation; neither the 2024 regulations nor section 52 of the Nationality and Borders Act have been repealed by the Bill, so the capacity to use scientific age assessments remains on the statute book.
The hon. Member for Stockton West did not seem to know which age assessment methods we were talking about. The 2024 regulations specify the power to use X-rays and MRIs, and that it is possible to take a negative view of the credibility of a person who refuses to consent, where there are no reasonable grounds for refusing that consent.
With those measures on the statute book, the Government continue to explore methods to improve the robustness of age assessment processes by increasing the reliability of the scientific methods being used. At the moment, we do not have enough certainty about the gap that exists in the current assessments, which are still being assessed. The hon. Member for Stockton West and the Conservative party put these things on to the statute book but then did not operationalise them. At the moment, we are doing as much work as we can to see how reliable they are, with a view to operationalising them. But as I wrote in a response to shadow Home Secretary, the right hon. Member for Croydon South, when he wrote to me about this issue, we are in the middle of that process. I hope that we will soon be in a situation to make announcements one way or the other, and those announcements will be made in the usual way.
Matt Vickers
New clause 26 does not specify the method to be used; it commits the Government to coming back within six months with a statutory instrument. How long does the Minister think it will be before the Government are in a position to do that? Is it six months’ worth of people coming here without our having the ability to assess them without their consent using these methods? Is it a year? Is it 18 months? How long does she think it will be before we are in a position to make these decisions?
Dame Angela Eagle
We are making a scientific assessment of how accurate and effective the methods are that could be used to make age assessments, and I hope to have some results from that work soon. What I do not want is to have a clause in primary legislation telling me that I have to do that by a set time.
I am trying to reassure the hon. Gentleman that despite the repeal of section 58 of the Illegal Migration Act, which this Bill brings about, the capacity to do age assessments and apply them scientifically is still on the statute book. We are looking closely into how we can operationalise these methods if we feel they will give us a more trustworthy result, but we will not do that if we do not. We are in the middle of getting to the stage where we can make that judgment.
I will also address new clause 43, which says that we should not use age assessments at all, other than in exceptional circumstances. Given what the hon. Member for Perth and Kinross-shire said when he moved it, I think it accepts that we should continue with Merton assessments, which are the other way of dealing with age assessments currently. Those usually involve two social workers and various other experts interviewing the person concerned to try to get a handle on their real age.
Matt Vickers
I welcome the fact that the Government will come back with scientific age assessments that also do not require consent. But if six months is too long, at what point would the Minister expect to be concerned? If we have not been applying these assessments and we have ended up with the wrong people in the wrong classrooms for years, at what point should we be concerned? If six months is too soon, is it 18 months?
Dame Angela Eagle
The hon. Gentleman is being a bit mischievous. We are in the middle of an assessment of whether scientific age assessments work and at what level of capacity and detail we can trust them. I expect reports fairly soon, and once I have them I can make a decision on how we go ahead with them. I will let Parliament know in the usual way when that has happened, but it is not useful or effective to have the hon. Gentleman’s new clause setting a deadline for that in the Bill. I hope he will accept that in the helpful way in which I intend it. We are not in disagreement on principles, but if we are going to use scientific age assessment, we need to ensure that it is as effective and useful as possible, so that it can be taken seriously and play an effective part in the battle that all of us want to be involved in: ensuring that children do not end up in adult settings and adults do not end up in children’s settings.
Matt Vickers
People who arrive here deceptively claiming to be children cannot be allowed to succeed. We should make use of the best scientific age assessment methods available to us, with or without consent. Those will not be used in isolation, but alongside all the other possible assessment methods available to us. We can debate the science all day. The new clause would require the Secretary of State to define those methods within six months through a statutory instrument, using expert advice to do so. One deceptive adult migrant in a classroom or care setting alongside children or vulnerable youngsters is one too many. Giving our agencies the ability to use the best scientific methods available to them to assess age without consent can further their ability to protect children. I would therefore like to press new clause 26 to a Division.
Pete Wishart
I am grateful to the Minister for her response to my new clause 43, but a lot of what she claims is in it is not actually there—I hope she accepts that. Those of us who visit asylum seekers in our constituencies will recognise that the determination is probably the most contentious issue that asylum seekers bring to us; it is the thing that perplexes and concerns them the most. They are very sensitive to it being done wrong, and it gets done wrong in both directions, as the Minister said.
The number of children found to have been misclassified as adults outweighs quite significantly the number of cases where an asylum seeker has falsely claimed to be a child. Everybody is right that there is no scientific or other method to determine age that is 100% effective—visual assessments certainly are not. Surely, however, the people who are best qualified to make these assessments are people who work with children—whose main business is to make these sorts of judgments about children. That is why we have asked for Merton-compliant age assessments, so that an holistic view is taken of the individual and they are assessed properly by social workers trained to work with children. Surely that is the most effective means to determine these things.
I am not saying that we should not use other things, but where the issue is in dispute—perhaps I should have included that in my new clause; clearly, the people sitting in this Committee could not be classified as children—we must get it right. That is so important as we go forward. It is life-changing, dangerous and damaging to be misclassified. As I said in my initial contribution, this is not an immigration issue, but a safeguarding issue. We must get it right. That is why I will press my new clause to a vote as well.
Question put, That the clause be read a Second time.
Public Authorities (Fraud, Error and Recovery) Bill (Twelfth sitting)
Tuesday 18th March 2025
(2 days, 11 hours ago)
Public Bill CommitteesPublic Authorities (Fraud, Error and Recovery) Bill 2024-26 View all Public Authorities (Fraud, Error and Recovery) Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 18 March 2025 - (18 Mar 2025)
The Committee divided: - Ayes: 3 / Noes: 11 - Question accordingly negatived.
The Committee divided: - Ayes: 3 / Noes: 10 - Question accordingly negatived.
The Committee divided: - Ayes: 6 / Noes: 9 - Question accordingly negatived.
The Chair
I remind Members to send their speaking notes by email to hansardnotes@parliament.uk, and to ensure that all electronic devices are switched to silent. I also remind Members that tea and coffee are not allowed during sittings. It is going to be a busy morning. Please speak through the Chair, as usual, and refrain from using “you” unless you wish to speak to me.
New Clause 1
Overpayments made as a result of official error
“(1) Section 71ZB of the Social Security Administration Act 1992 is amended as follows.
(2) In subsection (1), for ‘The’ substitute ‘Subject to subsection (1A), the’.
(3) After subsection (1) insert—
‘(1A) The amount referred to in subsection (1) shall not include any overpayment that arose in consequence of an official error where the claimant or a person acting on the claimant’s behalf or any other person to whom the payment is made could not, at the time of receipt of the payment or of any notice relating to that payment, reasonably have been expected to realise that it was an overpayment.’”—(Siân Berry.)
This new clause would provide that, where universal credit overpayments have been caused by official error, they can only be recovered where the claimant could reasonably have been expected to realise that there was an overpayment.
Brought up, and read the First time.
Siân Berry (Brighton Pavilion) (Green)
I beg to move, That the clause be read a Second time.
It is a pleasure speak under your chairship again, Mr Western. I tabled the new clause as a probing amendment. In short, it would bring the test for the recovery of universal credit overpayments caused by official error into line with regulation 100(2) of the Housing Benefit Regulations 2006, meaning that they could be recovered only where the claimant could have reasonably been expected to realise that there was an overpayment.
Let me provide some background on why the new clause is needed. According to Department for Work and Pensions data, in 2023-24 the best part of 700,000 of the new universal credit official error overpayment debts entered into the DWP’s debt management system were caused not by fraud or claimant error but by Government mistakes. Unlike for many other benefits, the DWP can recover official error universal credit overpayments from claimants. This power was introduced through the Welfare Reform Act 2012, and represented a significant change to the position that previously applied to most legacy benefits.
When concerns were raised at the time, assurances were provided by the then Employment Minister that the DWP did
“not have to recover money from people where official error has been made”
and that
“we do not intend, in many cases, to recover money where official error has been made.”––[Official Report, Welfare Reform Public Bill Committee, 19 May 2011; c. 1019.]
However, Public Law Project research shows that the DWP’s default approach is to recover all official error overpayments. Relief is dependent on individuals navigating a difficult and inaccessible process to request a waiver. In 2022, only 26 waiver requests were granted.
DWP mistakes matter. The financial and psychological impacts of overpayment debt recovery on individual claimants can be severe. The research I have mentioned found that the recovery of debts, including official error overpayments, by deductions from universal credit led to a third of survey respondents becoming destitute. The risk of harm is particularly acute for official error overpayments, which individuals have no way of anticipating, so they can lead to sudden, unexpected reductions in income that impact existing fixed commitments and carefully planned budgets.
The recovery of official error overpayments brought an added sense of injustice, with individuals finding themselves in debt due to a DWP error over which they had no control. For example, one claimant was overpaid universal credit because the DWP had failed to consider income from her widow’s pension. She had informed the DWP that she received it and was assured that it would not affect her claim. She relied on that assurance and spent the money on daily living expenses. Four years later, the DWP told her that it would be recovering the resulting overpayment of £7,258.08. Aside from the significant financial impact, the stress associated with recovery impacted her mental health. She found herself constantly thinking about the overpayment and how she would pay it back, which in turn impacted on her physical health. She was left anxious that mistakes would be made again, leading to her incurring debt that she had no power to avoid.
Recovery often puts individuals who have relied on payments in good faith in financially precarious situations, forcing them to make difficult choices about sacrificing essentials. Research by the Joseph Rowntree Foundation has found that the current standard universal credit allowance is not sufficient to cover the cost of essentials. In this already difficult context, households that are repaying overpayment debt can lose up to 25% of their standard allowance each month.
People often base key life decisions and financial planning on information provided by DWP officials about their entitlement to universal credit. An official error universal credit overpayment can also have a knock-on effect on people’s entitlement to other support, such as council tax reduction. I am sure the DWP does not want to be responsible for pushing someone into further financial hardship. We can prevent this harm from occurring in the first place with my new clause, which would mean that overpayments can be recovered only where the claimant could reasonably have been expected to realise that they had been overpaid.
The new clause is equivalent to an amendment proposed by Labour Front Benchers during the passage of the Welfare Reform Act. Under the new clause, DWP officials would themselves consider the fairness of recovering an official error overpayment before any recovery was initiated. Increasing protections against the recovery of overpayments would also create a strong incentive to reduce the rate of DWP errors in the first instance, thereby contributing to a more accurate and better functioning welfare system from the outset.
The Bill provides the Government with an opportunity to proactively address a harmful and unfair process that affects hundreds of thousands of claimants each year, easing the financial burden of debt on claimants who have done nothing wrong and encouraging the DWP to get payments right first time. I hope that the Minister will respond to my points on new clause 1, and I sincerely hope that we will make progress on the issue as the Bill progresses.
Rebecca Smith (South West Devon) (Con)
It is a pleasure to serve under your chairmanship, Mr Western. This is the first time that I have spoken to a new clause in Committee. New clause 1, tabled by the hon. Member for Brighton Pavilion, would amend the Bill so that, where universal credit overpayments have been caused by official error, they can be recovered only where the claimant could reasonably have been expected to realise that there was an overpayment.
I am interested to know how the claimant could reasonably be expected to realise that the amount that they had received was an overpayment, as that would be the test for whether that person becomes liable for repaying the amount. If payments are made to an appointee’s bank account, do they become liable for spotting the overpayment under this new clause? Would the amount have to be repaid only if both the person eligible for the payment and their appointee realised the overpayment?
Are there figures on how much money is lost and recovered due to error? Do we therefore know how much the new clause would cost the DWP? Underpayments in taxes are recovered by His Majesty’s Revenue and Customs in the following months or years even where the individual is not at fault, and it is not clear why universal credit claimants should be any different. It would help if the Minister could explain to the Committee how, in the case of overpayments, a repayment plan will be put in place that is manageable for the person making the payments, and how that will be assessed.
We would be better off focusing on minimising official errors in the first place. What work is the DWP doing to better guard against overpayments, given that the overpayment rate for universal credit was 12.4% or £6.46 billion in the financial year ending 2024, compared with 12.7% or £5.5 billion in the financial year ending 2023? I argue that we need to focus on ensuring that overpayments are not being made, but once the error has been made, particularly because it is so costly to the taxpayer, we should try to ensure that the money is recouped.
Steve Darling (Torbay) (LD)
It is a pleasure to serve under your chairmanship, Mr Western. I support the new clause tabled by the hon. Member for Brighton Pavilion. On several occasions over recent weeks, Ministers have gone on the record to describe the DWP and the benefits system as a “broken” system. It is extremely helpful that the hon. Member highlighted the impact that that can have on people who often have chaotic lives and are on the edge.
I have served the people of Torbay in elected office for 30 years. Over that time, I am saddened that, particularly with the recent cost of living crisis, the levels of destitution have become worse, as I hear from people who provide food banks and other support for the people in need in Torbay. Whether it is Scope or the Joseph Rowntree Foundation, many of those good organisations highlight to policy developers that the levels of benefits are really tough and the levels of destitution in our communities are higher than they have been for many years. Therefore, I would welcome some thoughts from the Minister about this proposal, because sadly, recovery will often drive people into destitution and, as highlighted by the hon. Member for Brighton Pavilion, into severe ill health.
The Parliamentary Under-Secretary of State for Work and Pensions (Andrew Western)
It is a pleasure to serve under your chairship once again, Mr Western. Before I come to my general comments on the new clause from the hon. Member for Brighton Pavilion, I will attempt to respond to some of the questions that we have heard.
On how we can assure ourselves that people could reasonably have known, this assessment is made by our specialist investigation teams, who do this day in, day out. There is a balance of probabilities that they would apply to instances such as that. It is a process that has been in place for years. On whether an appointee would be liable for an overpayment, yes, they would. How much is official error? It is approximately 0.3% of all benefit payments. About £800 million is the most recently available annual figure.
On how a repayment plan is agreed—this goes to the point that the hon. Member for Torbay made also—we again have a specialist team who calculate this. We have a vulnerability framework should that be required. All repayment requests are done on an affordable basis. As we heard last week, the specifics around the new debt recovery power make attempts, throughout the process, to agree an affordable repayment plan. The limits that the Bill would put in place would be not more than 40% in the case of an ongoing deduction and 20% in cases of error. On the point about recovery causing destitution, which the hon. Gentleman also made, he will have noted that towards the end of last year, the Department announced its new fair repayment rates, reducing the amount of deduction that can be made from benefits down to 15%. As I have just outlined, further provision is made where we are looking to take these new powers to deduct directly from bank accounts.
To return to the point that the hon. Member for South West Devon made about prevention of overpayments, the eligibility verification measure is intended to help us to identify fraud, particularly in relation to capital, and people who have been abroad longer than they should be, in terms of aligning that with their eligibility for benefits, and we think that it will enable us to identify error overpayments sooner as well. Of course, people are regularly reminded to update their circumstances also. A range of mechanisms are in place already to assist with the identification of overpayments. We are not complacent. We know that there are too many overpayments through official and claimant error, just as there is far too much fraud in the Department. That is why we are taking many of the steps identified and outlined in this Bill.
Before I turn to my comments about new clause 1 specifically, let me just make a correction to something that I told the Committee last week. I said that the minimum administrative penalty that can be offered, which receives a four-week loss of benefit, is £65. I misspoke and I would like to take this opportunity to correct the record and state that the amount is £350.
New clause 1 seeks to amend existing recovery legislation, to limit when overpayments of universal credit and new-style benefits caused by official error could be recovered. Specifically, those official error overpayments would be recoverable only where the claimant could have been reasonably expected to realise they were not entitled to the overpayments in question at the time they received them. This Government are committed to protecting taxpayers’ money and ensuring that we can recover in a fair and affordable way money owed. The debt recovery powers in the Bill apply to all debt that Parliament has determined can be pursued. Section 71ZB of the Social Security Administration Act 1992, introduced in the Welfare Reform Act 2012 under the coalition Government, made any overpayment of universal credit, new style jobseeker’s allowance and employment and support allowance in excess of entitlement recoverable. That includes overpayments arising as a result of official error.
Official error can arise for a number of different reasons. Some errors, for example, occur as a result of the flexibility of the universal credit system. Unlike the tax credit system it replaces, UC works on a monthly cycle of assessment periods. It is to be expected that on occasion, corrections or changes take place over assessment periods. The system quickly rectifies these “errors” in the next assessment period and it is vital that this functionality is maintained. In these instances, the customer is not worse off as, over the course of subsequent assessment periods, they receive the correct amount on average. It is also helpful to explain that under existing departmental processes, customers have the right to request a mandatory reconsideration of their benefit entitlement as well as the amount and period of any subsequent overpayment. Following that, they can appeal to the first-tier tribunal, should they still disagree with the Department’s decision.
We recognise that overpayments, however they arise, cause anxiety for our customers. The Department’s policy is therefore to recover debts as quickly and cost effectively as possible without causing undue financial hardship to customers. DWP’s overall approach to recovery balances the need to protect public funds by maintaining recovery levels, while providing a compassionate service to all customers regardless of their circumstances. The Department’s policy is therefore to agree affordable and sustainable repayment plans. The debt recovery measures in the Bill, however, are last-resort powers for debtors who are no longer on benefits or in pay-as-you-earn employment and are persistently evading debt recovery. These powers apply across all types of debt.
All our communications to our customers signpost to independent debt advice and money guidance, and we heard from the Money and Pensions Service in our evidence sessions about how strong the partnership working between the Department and debt sector is. DWP is committed to working with anyone who is struggling to repay their debt and customers are never made to pay more than they can afford. Where a customer feels they cannot afford the proposed rate of recovery, they are encouraged to contact the Department to discuss their repayment terms. The rate of repayment can be reduced or recovery suspended for an agreed period, and the Department may also consider refunding the higher deduction that has been made. The Department’s overpayment notifications have been updated to make sure customers are aware they can request a reduction in their repayment terms. In exceptional circumstances, the Department has the discretion to waive recovery of the debt, in line with the Treasury’s “managing public money” guidance. In doing so a range of factors are considered including the circumstances in which the overpayment arose.
Finally, I have listened to and take seriously the concerns from the hon. Member for Brighton Pavilion. As the Committee is aware, the Minister for Social Security and Disability is looking at the policy design of universal credit to ensure outcomes that tackle poverty and help people to manage their money better. I will pass the concerns raised by the hon. Lady on to him, but having outlined the reasons against it, I will resist new clause 1.
Siân Berry
I thank the Minister for taking seriously the concerns I raised. I will not press the new clause further today, but I hope that it will be looked at seriously in the next stages of the Bill, and that we can discuss this further in the House. I therefore beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 2
Offence of fraud against a public authority
“(1) A person who—
(a) commits,
(b) assists or conspires in the committal of, or
(c) encourages the committal of
fraud against a public authority commits an offence.
(2) A person who commits an offence under subsection (1) is liable—
(a) on summary conviction, to imprisonment for a term not exceeding the general limit in a magistrates’ court or a fine (or both);
(b) on conviction on indictment, to imprisonment for a term not exceeding 7 years.”—(Rebecca Smith.)
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss new clause 15—Offence of encouraging or assisting others to commit fraud—
“(1) The Social Security Administration Act 1992 is amended as follows.
(2) In section 111A (Dishonest representation for obtaining benefit etc), after subsection (1G) insert—
‘(1H) A person commits an offence if they—
(a) encourage or assist another person to commit an offence under this section, or
(b) provide guidance on how to commit an offence under this section.’
(3) In section 112 (False representations for obtaining benefit etc), after subsection (1F) insert—
‘(1G) A person commits an offence if they—
(a) encourage or assist another person to commit an offence under this section, or
(b) provide guidance on how to commit an offence under this section.’”.
Rebecca Smith
I beg to move, That the clause be read a Second time.
New clause 2 seeks to make it a specific offence to commit, assist or encourage others to commit fraud against a public authority. Someone who commits such an offence would be liable to imprisonment or a fine, or both.
The offence of fraud against a public authority in the Bill is a civil offence. The Government argue that civil penalties offer an alternative to prosecution and help to mitigate the burden on the criminal justice system by offering alternative routes for the public sector to manage fraud cases. The Bill introduces a framework of civil penalties for fraud that the Minister can impose, including on behalf of other Government Departments, serving as an important deterrent against fraud in the public sector. We think it is an anomaly for public sector fraud to be a civil offence while benefits fraud is a criminal offence. Will the Minister explain why one type of fraud is seen as less serious than the other?
The Parliamentary Secretary, Cabinet Office (Georgia Gould)
It is a pleasure to serve under your chairmanship, Mr Western. I appreciate the intention of the hon. Member for South West Devon in tabling the new clause—that is, to take fraud against the public sector seriously—but the Government plan to resist it, because we believe that the proposals are already covered and that it could lead to unintended consequences that do the opposite of what she wants.
As the hon. Member said, new clause 2 would create a new offence of fraud against a public authority. We believe that that could have a detrimental effect and is unnecessary, because fraud is already an offence, and this is clearly defined in clause 70 as offences under the Fraud Act 2006 and the common law offence of conspiracy to defraud. The Bill uses those offences—they do not need to be written into it to have effect—and we have given assurances on that during a previous debate.
Consequently, there does not need to be a specific fraud offence for public authorities. Assisting and encouraging fraud against a public authority, as is mentioned in the new clause, is already an offence. The offences of “encouraging or assisting”, as set out in sections 44 to 46 of the Serious Crime Act 2007, apply to fraud offences as they do to other crimes. Again, that does not need to be written into the Bill to have effect.
The Public Sector Fraud Authority will be able to investigate cases in which it appears that someone has encouraged someone else to commit fraud. If we discover encouragement, that would likely form part of the PSFA’s investigation into a fraud case, and the Crown Prosecution Service could pursue that offence using the evidence collected. Whether action can be taken will depend on the facts of the case, the evidence available and whether the necessary standard of proof can be met.
Crucially, new clause 2 would reduce the maximum sentence available for Fraud Act and conspiracy offences from 10 years to seven years, for fraud against public authorities only.
Mike Wood (Kingswinford and South Staffordshire) (Con)
I thank the Minister for her response, but why does she feel that benefit fraud ought to be a specific offence, with maximum sentences under the Social Security Administration Act 1992, but that it is not appropriate for a specific offence to apply to people who deliberately defraud other public authorities?
Georgia Gould
As I set out, these measures are already covered, and the proposals would potentially reduce sentences from 10 years to seven years. I am sure that the hon. Member does not want those who defraud the public sector to get lower sentences than those who would defraud the private sector.
Mike Wood
The Minister is being generous in giving way. Prosecutors have a choice as to which charge to bring. They can still bring a charge under the common law offence, which as the Minister says, has a high maximum sentence—but one that is very rarely imposed—or, as with benefit fraud, they could bring it under a specific offence, as proposed in new clause 2. The Sentencing Council would then develop the guidelines that apply to deliberately defrauding public authorities. Although the Minister is right that the maximum sentence under the new clause is lower than the theoretical maximum for the common law offence, in practice, it is likely to see rather more substantial sentences imposed on conviction.
Georgia Gould
We already have effective fraud legislation. The issue that the Bill seeks to address is that we do not currently have the resources or the powers to properly investigate that or to recover money. We believe that the suggestions that are being made would have the unintended consequences of reducing the seriousness of the offence, in the way that I have set out. The proposals also omit the option available in the Fraud Act offences and the common law conspiracy offence for the Crown court to impose an unlimited fine instead of, or as well as, a term of imprisonment. Again, that weakens the response. That is contrary to the Government’s intention with the Bill that strong action should be taken against public sector fraud.
New clause 15 seeks to introduce an offence of encouraging or assisting others to commit fraud by adding new subsections to sections 111A and 112 of the Social Security Administration Act 1992. Sections 111A and 112 set out two specific offences related to benefit fraud. Although the intention behind the new clause is commendable, I believe that it is not needed for several reasons, which are similar to those I have set out on new clause 2.
First, the existing legal framework already provides sufficient measures to tackle fraud of this nature. The Fraud Act 2006 and the Serious Crime Act 2007 make it a criminal offence to encourage or assist any other offence, including when it relates to fraud. There are also existing laws that serve a similar purpose for Scotland. Those existing laws are robust and comprehensive, ensuring that individuals who provide guidance on how to commit fraud, or encourage others to do so, can be prosecuted effectively. Introducing additional subsections to the 1992 Act would therefore be redundant and unnecessary.
Secondly, the new clause could potentially complicate the legal landscape. Adding new subsections to the 1992 Act risks creating overlapping and conflicting provisions that could lead to confusion and inefficiency in enforcement. It is essential to maintain clarity and coherence in our legal system to ensure that justice is served effectively. Moreover, the new clause would mean that those convicted of a new offence would face a less punitive sentence than they would under existing laws. For example, under new clause 15, a conviction related to section 112 would carry a maximum period of custody of three months, compared with a maximum of 10 years under the existing Fraud Act. As a result, and this is similar to what I set out on new clause 2, rather than strengthening our position to respond to such types of fraud, new clause 15 could result in a weakened response.
Although new clauses 2 and 15 are well intended, neither new clause is needed as the existing legal framework already provides sufficient measures to address this issue, and introducing additional subsections would only complicate the legal landscape. However, I very much heard the points about the research being done by the hon. Member for South West Devon and the importance of tackling those who set up sites to try to defraud the public sector. I am more than happy to have a further meeting about how we can take action on that. We believe that we can do that using the existing powers, but we would welcome further discussion. The PSFA and DWP will be concentrating on the provisions in the Bill that are intended to effectively address and combat fraud through them. I therefore ask the hon. Member for South West Devon to withdraw the motion.
Rebecca Smith
I have heard everything that the Minister has said. However, we will still press new clauses 2 and 15 to a vote.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
On a point of order, Mr Western. It is a pleasure to serve under you in the Chair; can I ask you a procedure question before we go any further? We have had the presentation of the new clauses, but we have not had any declarations of interest. Given that there are some notable Conservative party donors facing potential fraud charges under covid issues, I just wonder whether that should have been declared before we got to the change in how people in those situations might be punished.
The Chair
I understand, although I was not present at the time, that all the declarations were made at the time of evidence being presented to the Committee. I thank the hon. Member for his point of order.
Andrew Western
I would like to understand how the Opposition Front-Bench team consider new clause 15 to make any provision that is not already in the Fraud Act 2006 or the Serious Crime Act 2007, which already make it an offence to encourage or assist an offence including fraud. I stress that because I am particularly concerned about sickfluencers, to whom the hon. Lady referred, but I fail to see how new clause 15 offers any provision not contained in that legislation already. It does not mention at any point that it would extend powers to what happens online, presumably because—or I can say actually because—online sickfluencers would already be covered by that legislation. I understand the intent. We have a problem with sickfluencers that we need to deal with, but I would be incredibly appreciative to understand how the new clause offers anything that is not already in that legislation.
Rebecca Smith
I thank the Minister for his comments. I have obviously heard what both Ministers have said in response. We are still keen from a principle perspective to push the new clause to a vote because we think more needs to be done to outline specifically what we are doing to tackle the online aspect. I hear what the Minister is saying but, in this particular instance, we would like to take it further.
Question put, That the clause be read a Second time.
Rebecca Smith
I beg to move, That the clause be read a Second time.
We have tabled the new clause to require the Secretary of State to publish the results of any pilot schemes run with banks to test the provisions of chapter 1 of part 2 of the Bill. We have already discussed how banks will be required to undertake ongoing monitoring work to collect the relevant information as part of eligibility verification. The impact assessment states that two proofs of concept have taken place, including one in 2017, with short summaries provided of each. Given the scale of what is being asked of the banks, however, as well as how technology has moved on in the past eight years, it is reasonable to assume that pilots will also be undertaken to ensure that the system works properly before it is fully rolled out. Can the Minister confirm that this will be the case?
In the interest of transparency, we also need to see the results of the pilots, which is why we have tabled the new clause to ensure that they are published within three months of the Act coming into force. It is regrettable that we needed to table the new clause but, as we have said several times throughout the Bill’s passage, and as we heard from witnesses before the Committee, it is extremely difficult to judge how the legislation will work in practice without seeing the code of practice and understanding what will be required of the banks. As UK Finance said in oral evidence:
“Much will depend on the mechanism through which banks will be required to share the information, the frequency of the information notices, whether the criteria we are required to run the checks against change over time and other factors that will influence how much capacity is required from the banking sector. As I say, at this stage it is challenging to do a detailed assessment.”––[Official Report, Public Authorities (Fraud, Error and Recovery) Public Bill Committee, 25 February 2025; c. 48, Q85.]
The practical implications of how to implement the Bill are not currently clear to the banks.
We also discussed the consequences of getting this wrong. As UK Finance also said in evidence,
“under the Bill banks responding to an information request or a direct deduction order, would have to consider whether there is some indication of financial crime that under POCA requires them to make a suspicious activity report. We think it is simpler to remove that requirement, not least because where there is a requirement to make a suspicious activity report there is a requirement to notify the authorities; clearly, there is already a notification to the authorities when complying with the measure. Removing that requirement would avoid the risk that banks must consider not only how to respond to the measure but whether they are required to treat that individual account as potentially fraudulent.”––[Official Report, Public Authorities (Fraud, Error and Recovery) Public Bill Committee, 25 February 2025; c. 49, Q89.]
The banks are well versed in dealing with fraud, but not so much with error. We need reassurance that there are clear expectations of the banks in delivering their duties under the Bill, that those are compatible with existing obligations regarding financial crime, and that the banks can resource them.
Andrew Western
In my view, the new clause is simply not needed. As the hon. Lady said, to demonstrate the feasibility and potential of the eligibility verification measure, the DWP conducted two proofs of concept, in 2017 and 2022, and the results have been published in the impact assessment for the Bill. Further information on the effectiveness of the measure will, of course, be available following the independent overseer’s annual review and report. No pilot schemes have or will be conducted on information notices specifically, as they are an extension of existing powers. On that basis, I resist new clause 5.
Rebecca Smith
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 7
Annual reporting of amounts recovered
“(1) The Secretary of State must publish an annual report detailing the amount of money which has been recovered under the provisions of this Act.
(2) A first report must be published no later than 12 months after the passing of this Act with subsequent reports published at intervals of no more than 12 months.”—(Rebecca Smith.)
Brought up, and read the First time.
Rebecca Smith
I beg to move, That the clause be read a Second time.
The new clause would require the Secretary of State to publish an annual report detailing the amount of money recovered under the provisions of the Bill, with the first report to be published within 12 months of its passage. The main purpose of the Bill is to crack down on error and fraud, and we support that aim. It is reasonable to ask for transparency to understand exactly how much money has been recovered thanks to the measures in the Bill, and to ensure that it is working as hoped. If it is not, further action will be needed, but at least we would know, and a discussion could be had instead of the issue being brushed under the carpet.
An annual report allows the Department enough time to produce it without being an administrative burden, while ensuring that it remains relevant and up to date. Given the large amount of money lost to fraud and error, it is important that we are all able to hold the Government to account for how effectively they are recovering it.
Andrew Western
I share and appreciate the hon. Member’s concern and interest in delivering the proposed benefits of the Bill, including the effective recovery of debt. The Bill delivers on our manifesto commitment that this Government will safeguard taxpayers’ money and not tolerate fraud or waste anywhere in public services.
Turning first to part 2 of the Bill, I do not think the new clause is necessary, given the existing routes for external scrutiny and reporting on the DWP’s fraud and error activities, including the new debt recovery powers. The Office for Budget Responsibility provides independent scrutiny of the Government’s costings of welfare measures. The Department estimates that, over the next five years, the EVM will save £940 million and the debt recovery measure £565 million. Those estimates have been certified by the OBR. In total, the Bill is estimated to deliver benefits of £1.5 billion over the next five years. In the published impact assessment, the DWP committed to monitoring and evaluation on part 2 of the Bill, including the new powers to recover debt and the EVM.
Although I understand that the hon. Member is particularly interested in scrutiny of the money recovered under the Bill, I remind the Committee that the Government have committed to the biggest welfare fraud and error package in recent history. The total DWP fraud, error and debt package, with savings from the Bill and other Budget measures, is worth £8.6 billion over the next five years.
In its annual report and accounts, the DWP already reports on the savings made from its fraud and error activities, including savings made from “detect” activity across our counter-fraud and targeted case review teams. In addition, we report on our debt recovery totals and debt stock. I think the annual report and accounts, in particular, will give the hon. Member the information in which she is interested. The Department also publishes annual statistics on the monetary value of fraud and error, including various breakdowns by benefit and type. That is another mechanism by which we can see trends over time and ensure transparency for the public.
Turning to part 1 of the Bill, the PSFA already has a published commitment in its mandate to produce an annual report that makes transparent the levels of fraud in Government and the latest fraud and error evidence base, and an annual report on its performance. Recoveries will be published in the annual report. Paragraph 12 of schedule 2 to the Bill also requires:
“As soon as reasonably practicable after the end of each financial year the PSFA,”
when set up as a statutory body,
“must prepare a report on the exercise of its functions during that financial year.”
Recoveries will be published as part of that.
For the reasons I have outlined, I resist the new clause.
Rebecca Smith
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 8
Publication of an Anti-Fraud and Error Technology Strategy
“(1) The Secretary of State must, within six months of the passing of this Act, publish an Anti-Fraud and Error Technology Strategy.
(2) An Anti-Fraud and Error Technology Strategy published under this section must set out—
(a) how the Government intends to use automated technologies or artificial intelligence to tackle fraud against public authorities and the making of erroneous payments by public authorities, and
(b) a series of safeguards to provide for human oversight of decision making that meet the aims set out in subsection (3);
(c) how rights of appeal will be protected;
(d) a framework for privacy and data sharing.
(3) The aims of the safeguards in subsection (2)(b) are—
(a) to ensure that grounds for decision making can only be reasonable if they are the result of a process in which there has been meaningful human involvement by a human of adequate expertise to scrutinise any insights or recommendations made by automated systems,
(b) to make clear that grounds cannot be reasonable if they are the result of an entirely automated process, and
(c) to ensure that any information notice issued is accompanied by a statement—
(i) setting out the reasonable grounds for suspicion that have been relied on, and
(ii) confirming that the conclusion has been formed on the basis of human involvement.”—(Rebecca Smith.)
Brought up, and read the First time.
Rebecca Smith
I beg to move, that the clause be read a Second time.
The new clause would require the Secretary of State to publish an anti-fraud and error technology strategy within six months of the Act’s passage. That must include: how the Government intend to use automated technologies and AI to tackle fraud, subsection (2)(a); safeguards to ensure human oversight of decision making, subsection (2)(b); protection of rights of appeal, subsection (2)(c); and a framework for privacy and data sharing, subsection (2)(d).
Members might be asking themselves why we tabled the new clause. In part, it is based on the evidence we received. In written evidence, the Public Law Project expressed concern that, although the impact assessment, the human rights memorandum and the statements from the Secretary of State and the Minister for transformation, the hon. Member for Stretford and Urmston, on Second Reading state that a final decision on benefit eligibility will always involve a human agent, this is not reflected in the Bill itself. In response to the Public Law Project’s concerns, the new clause would provide an audit of technology systems used to tackle fraud, ensuring accountability while addressing the risks posed by automation in decision making.
A report published by the Treasury in 2023, “Tackling fraud and corruption against government”, said:
“Public bodies can better protect themselves…by sharing data and intelligence with other public bodies and working together.”
We therefore believe the technology strategy clause recognises that sharing data is beneficial to stopping and recovering fraud, but includes additional provisions that audit its use.
The strategy must include: how the Government intend to use automated technologies or artificial intelligence to tackle fraud and error against public bodies; what safeguards exist for human oversight of decision making; how rights of appeal will be protected; and a framework for privacy and data sharing.
The safeguards must ensure that grounds for decision making are reasonable only if they are the result of a process in which there has been meaningful involvement by a human of adequate expertise to scrutinise any insights or recommendations made by automated systems. They must also make it clear that grounds cannot be reasonable if they are the result of an entirely automated process. To ensure this, any information notice issued must be accompanied by a statement setting out the reasonable grounds for suspicion that have been relied on, and confirming that the conclusion has been formed on the basis of human involvement.
We know that AI and other technologies have huge potential to improve efficiency and productivity, and they should be used where appropriate, but we cannot rely on it yet to the exclusion of people and human judgment. The strategy we propose would ensure that those points were adequately considered by the Department, ensuring that the taxpayer receives value for money while safeguarding claimants through the decision-making process.
Andrew Western
I thank the hon. Member for tabling the new clause. The Government recognise the opportunities that AI and machine learning can provide, while also understanding the need to ensure they are used safely and effectively. In January 2025, the Government outlined their response to the AI opportunities action plan led by Matt Clifford, which was commissioned by my right hon. Friend the Secretary of State for Science, Innovation and Technology. The plan outlined 50 recommendations for how the Government can leverage AI, including recommendations to improve access to data, to make better use of digital infrastructure and to ensure the safe use of AI.
Under the leadership of the Prime Minister and the Secretary of State for Science, Innovation and Technology, we have endorsed this plan, and the Government are taking forward those recommendations. As the Government work to implement the action plan’s recommendations, I do not believe that the separate anti-fraud and error technology strategy proposed by the new clause is necessary. I believe the new clause would cut across the work being taken forward under the action plan, so I reject the amendment.
As technology advances, the use of AI and machine learning will play a crucial role in detecting and preventing fraudulent activities. The Government want to make use of technology and data to tackle fraud, as the Department has a responsibility to ensure that fraud is minimised so that the right payments are made to the right people. The Government remain committed to building our AI capability, and at DWP we will take advantage of the opportunities offered by AI while ensuring it is used appropriately and safely.
Rebecca Smith
Sorry, I should have said this earlier. The new clause would make the Government’s AI strategy a statutory requirement, instead of a manifesto commitment not written into law. That is important to us because, in the case of fraud and particularly benefit fraud, we are dealing with individual people. We want to make sure that we do not inadvertently penalise the wrong people or apply something that is disproportionate. A lot has been said about ensuring proportionality and reasonableness.
I am interested in the Minister’s reflections on where else in the strategy something is applied as personally to potentially vulnerable groups of people, thereby suggesting that we do not need this protection to ensure that people are not inadvertently penalised when we use this legislation to tackle the fraud they are committing.
Andrew Western
That is a reasonable question, and clearly the AI framework is not specific to vulnerable groups in the way that the hon. Lady sets out. Decisions regarding benefit entitlement or payments within the Department are made by DWP colleagues who always look at the available information before making a decision. I would not want to make an amendment to restrict that to only the activity within this Bill; I would want it to be Departmental wide.
As I have set out a number of times at every stage and in every area of this Bill, a human is involved in decision making. There is no plan to change that. I can understand the hon. Lady’s anxiousness to see that set out in legislation, but I think it would create an anomaly between the practices within this Bill and in the Department more broadly. For instance, it is outside the scope of this Bill for a human to complete the vulnerability framework when looking at somebody in financial need who has an overpayment. I would not want to make a distinction between these powers and the rest of the Department's activities. If we were to have a broader debate, I would be happy to engage with the hon. Lady on that basis, but I would not want to create a “two-tier”, for want of a better word, description within the Department.
At every stage of model development, as we bring forward the AI opportunities action plan and our work in the AI and tech space, we ensure that checks, balances and strong safeguards are in place. I am proud of our commitment to use AI and machine learning in a safe and effective way.
To provide further assurances to Parliament and the public about our processes, we intend to develop fairness analysis assessments, which will be published alongside our annual report and accounts. These will set out the rationale for why we judge our models to be reasonable and proportionate. This reporting commitment on our fairness analysis assessment further negates the need for the new clause.
Finally, the hon. Lady mentioned the new clause’s role in ensuring reasonable grounds of suspicion when investigating fraud. I remind the Committee that, under the information gathering powers, the DWP may request information only where an authorised officer considers that there are reasonable grounds to suspect a DWP offence and that it is necessary and proportionate to obtain that information. Again, a human is fully baked into the process.
The changes made by the Bill will be reflected in the new code of practice. Updated mandatory training will be provided for staff, who will be accredited to use these new powers. Of course, with the eligibility verification measure in particular, but running throughout the Bill, the principle of independent oversight is very much in place. I hope that will provide the hon. Lady with the necessary information to show that the Government will use the information gathering powers only where there is a reasonable suspicion of fraud, and that this will have considerable human involvement. I agree that there is perhaps a broader conversation to be had about this at an appropriate time.
Rebecca Smith
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 9
Impact of Act on vulnerable customers
“(1) The Secretary of State must, within six months of the passing of this Act, lay before Parliament an assessment of the expected impact of the Act on vulnerable customers.
(2) For the purposes of this section, “vulnerable customers” means someone who, due to their personal circumstances, is especially susceptible to harm, particularly when a firm is not acting with appropriate levels of care.”—(Rebecca Smith.)
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss
New clause 12—Impact of Act on people facing financial exclusion—
“(1) The independent person appointed under section 64(1) of this Act must carry out an assessment of the impact of this Act on the number of people facing financial exclusion.
(2) The independent person must, after 12 months of the passing of the Act—
(a) prepare a report on the review, and
(b) submit the report to the Minister.
(3) On receiving a report the Minister must—
(a) publish it, and
(b) lay a copy before Parliament.”
This new clause would look into the impact of the Act on people facing financial exclusion.
Rebecca Smith
New clause 9 would require the Secretary of State to lay before Parliament, within six months of the Act’s passage, an assessment of its expected impact on vulnerable customers.
Concern has been expressed in written evidence about the Bill’s impact on disabled people. It is important to ensure that vulnerable people are not inadvertently harmed by the Bill. There was a discussion about vulnerable customers in oral evidence, with Daniel Cichocki and Eric Leenders both supporting the notion of an impact assessment while being concerned about the mental strain of being under suspicion. They said that the FCA is due to publish a thematic review on this imminently. We suggest that this strengthens the case for a comprehensive assessment by the Secretary of State.
We define “vulnerable customers” as those who due to their personal circumstances are especially susceptible to harm, particularly when a firm is not acting with appropriate levels of care, per the definition used by the Financial Conduct Authority, with which the sector is familiar. New clause 9 is necessary because some of the people impacted by the Bill will be vulnerable, and some will be repaying money they acquired not through fraud but through overpayments resulting from DWP error. As we heard from UK Finance, banks have duties when they suspect that financial crime is taking place, and although such errors are obviously not financial crime committed by the person who holds the account into which the payments have been made, there is a risk that the Bill does not sit well with those existing duties on banks.
We need to ensure that communication with vulnerable bank customers is of a sufficient standard, particularly where the DWP is recovering funds in cases where customer is not at fault, because the group of people we are talking about is likely to have high levels of vulnerability. If the Minister will not accept the new clause, I would be grateful for an explanation of the reasons why and, importantly, how the Government intend to undertake monitoring, which we believe is important.
The Liberal Democrats’ new clause 12 would require an independent assessment of the impact of the Bill on people facing financial exclusion. I am interested in whether the Liberal Democrats have a particular individual or organisation in mind which they think would be appropriate to undertake such an assessment, but we do not have a difficulty with the principle of the new clause.
Steve Darling
New clause 12 is about financial exclusion, as the hon. Member for South West Devon said. The Liberal Democrats’ concern is that, as this morning goes on, a number of safeguards are looking to be—for want of a better phrase—baked into the system by legislation, yet according to the Minister the only thing baked into the system is the involvement of human beings. That causes me, and I am sure other colleagues, concerns.
If an annual review were to take place of the Bill’s impact on people facing financial exclusion, conducted by the independent person appointed with the Minister publishing and sharing that with Parliament, we could ensure a level of transparency. While many of us would acknowledge that the Ministers in place at the moment are well-meaning individuals, who knows where we will be in 10 years’ time? This legislation needs to stand the test of time, so baking in these safeguards would be a positive way forward. I hope that the Minister will welcome that. I look forward to his comments.
Siân Berry
I have a lot of sympathy with both new clauses. It is really important that we look closely, as we are mandated to do, at the impact of the Bill on the people whose examples have been raised throughout the debate. The Minister should answer the questions asked by hon. Members, and if the Government will not do what is proposed in the new clauses, he should say what the Government will do instead.
Andrew Western
I begin with new clause 9, tabled by the hon. Member for South West Devon. I share her view that where the powers in the Bill are exercised, there should be a consideration of the vulnerabilities that customers may have, whether they be the customers of data holders such as banks or customers of Government —for example, DWP customers. However, I do not think that the new clause is necessary given the existing safeguards, oversight and reporting provisions in the Bill.
The Bill includes a number of protections for vulnerable people, including affordability considerations and protections for persons experiencing hardship, rights of review and appeal, and independent oversight. Those provisions have already been debated and considered by the Committee, so I will not labour the point, but I will comment on the provisions in the Bill for independent oversight, as they will play an important role here.
Rebecca Smith
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 10
Recovery of overpayments of Carer’s Allowance
“The Secretary of State may not exercise any of the powers of recovery under this Act in relation to a person who has received an overpayment of Carer’s Allowance until such time as—
(a) the Secretary of State has commissioned an independent review of the overpayment of Carer’s Allowance;
(b) the review has concluded its inquiry and submitted a report containing recommendations to the Secretary of State;
(c) the Secretary of State has laid the report of the independent review before Parliament; and
(d) the Secretary of State has implemented the recommendations of the independent review.” — (Steve Darling.)
This new clause would delay any payments being taken from people who the Government may think owe repayments on Carer’s Allowance until the independent review into Carer’s Allowance overpayments has been published and fully implemented.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss the following:
New clause 11—Audit of algorithmic systems used in relation to Carer’s Allowance overpayments—
“(1) An independent audit of algorithmic systems used in the assessment, detection or recovery of Carer’s Allowance overpayments must be conducted at least once every six months.
(2) Any audit under subsection (1) must be conducted by persons with relevant expertise in data science, ethics and social policy who have no direct affiliation with—
(a) the Department for Work and Pensions, or
(b) any person or body involved in the development or operation of the algorithmic systems under review.
(3) An audit conducted under this section must consider—
(a) the accuracy of the algorithmic systems in identifying overpayments, and
(b) the fairness of the systems’ design, application and operation, including any disproportionate impact on particular groups.
(4) After every audit a report on its findings must be—
(a) published;
(b) laid before both Houses of Parliament within 14 days of publication; and
(c) made publicly available in an accessible format.
(5) If any audit identifies significant inaccuracies, unfairness or biases in any algorithmic systems, the Secretary of State must, within 30 days of the publication of the report outlining these findings, present an action plan to Parliament which outlines the steps which the Government intends to take to address the identified issues.”
This new clause would provide for an audit of algorithmic systems used in relation to Carer’s Allowance overpayments.
Amendment 32, in clause 103, page 63, line 26, leave out from start to “following” in line 29 and insert—
“Subject to subsections (1A) and (2), this Act comes into force on such day as the Secretary of State or the Minister for the Cabinet Office may by regulations appoint.
(1A) No part of this Act may come into force until the recommendations of a report commissioned under section [Recovery of overpayments of Carer’s Allowance] have been implemented.
(2) Subject to subsection (1A), the”.
Steve Darling
I encourage colleagues to support these proposals about the carer’s allowance. Carers are the backbone of many households across the United Kingdom, and I hope the Minister will support the amendment.
John Milne (Horsham) (LD)
It is a pleasure to serve under your chairmanship, Mr Western.
The DWP is making extensive and growing use of algorithms for investigation purposes. Without proper oversight, these systems threaten error, unfairness and bias, which could lead to wrongful debt collection. Our amendment therefore calls for an independent audit of these systems at least every six months, to ensure accuracy and fairness. The audit must be conducted by experts in data science, ethics and social policy with no ties to the DWP or system developers. True independence is key.
The audit look at issues such as accuracy, so whether the algorithms are correctly identifying overpayments; fairness, so whether they unfairly target certain groups or operate with bias; and, above all, transparency and accountability. After each audit, we suggest that a full report must be published, presented to Parliament within 14 days, and made publicly accessible. If serious flaws are found, the Secretary of State must respond within 30 days with a clear action plan to fix these issues. Overall, Liberal Democrats are positive about benefiting from new technology, but we do need to consider whether it offers help, not harm.
In the wider context, what work is the use of AI generating? There are already chronic staff shortages at the DWP, with 20% vacancy rates becoming routine. Disability Rights UK has commented that operational failures now permeate every layer of welfare administration. Fraud investigation teams therefore already lack capacity to address the annual £6.4 billion of overpayments. There are only four fraud advisers per regional office to handle cases flagged by frontline staff, which has created a bottleneck, so that very often 90% of suspected fraud cases go uninvestigated. In other words, one could suggest there is already plenty of fraud to investigate without trawling for more. This amendment ensures regular scrutiny, transparency and fairness. I urge the Minister to consider it.
Andrew Western
It is important that I begin by paying tribute to the millions of unpaid carers across this country. The Government recognise and value the vital contribution made by carers every day in providing significant care and continuity of support to family and friends, including pensioners and those with disabilities. The 2021 census indicates that around 5 million people in England and Wales may be undertaking some unpaid care, and many of us take on a caring role at some point in our lives. Like other hon. Members, through my postbag and at events across my constituency, I see much of the work carers do. Carers are fortunate to have some wonderful advocates, not only their MPs but organisations such as Carers UK, Carers Trust and the Learning and Work Institute, to name but three.
We inherited a system in which busy carers already struggling under a huge weight of responsibility had been left having to repay large sums of overpaid carer’s allowance, sometimes worth thousands of pounds. We needed to understand exactly what had gone wrong so we could set out our plan to put things right. This is why we launched an independent review of earnings-related overpayment of carer’s allowance. We were delighted that Liz Sayce OBE agreed to lead this review, which is now well under way; we anticipate receiving its conclusions this summer.
The review will investigate how overpayments of carers allowance have occurred, what can be done to best support those who have accrued them, and how to reduce the risk of these problems occurring in future, but we are not sitting back and just waiting for the outcome of the independent review. Right now, we want to make it as easy as possible for carers to tell us when something has changed in their life that could affect their carer’s allowance, so we will continue to review and improve communications. From this April, the weekly carer’s allowance earnings limit will pegged to 16 hours’ work at national living wage levels, so in future it will increase when the national living wage increases. The earnings limit will be £196 a week net earnings, up from £151 today. As a result, over 60,000 more people will be able to receive carer’s allowance between 2025-26 and 2029-30. That is the largest increase in the earnings limit since carer’s allowance was introduced in 1976.
As the Chancellor said at the Budget, we need to look at the current cliff edge earnings rules. A taper could further incentivise unpaid carers to do some work and reduce the risk of significant overpayments, but introducing a taper to carer’s allowance is not without challenges. It could significantly complicate the benefit, and significant rebuilding of the carer’s allowance system would be required. The DWP has begun scoping work to see whether an earnings taper might be a feasible option in the longer term, but any taper is several years away.
New clause 10 sets out four points. As I have mentioned, an independent review has been commissioned, its terms of reference have been published and it is well under way. It is anticipated that it will report its conclusions in the summer. Both the report from the independent review and the Government’s response will be published, and we will report to the House.
I disagree with the hon. Member for Torbay on two issues. It would not be responsible of us to commit in advance to implementing all and any recommendations from such a review, sight unseen. We need to consider them carefully. In addition, the proposed new clause, as I understand it, would not have the effect he desires. We would still be able to recover overpayments of carer’s allowance from benefits under the powers in the Social Security Administration Act 1992.
The new clause would prevent our recovering debts directly from bank accounts of those not on benefits or PAYE, which is one of the additional powers given in this Bill. Even if the new clause operated as intended, it would be disproportionate to suspend all recovery of carer’s allowance overpayments until after the review is concluded, as those with overpayments are already covered by the usual safeguards of appeal rights, affordable deductions and, in exceptional circumstances, waiver. Given the discrepancy this would create between those on PAYE and benefits and those with other forms of income, I hope the hon. Gentleman acknowledges the need to withdraw the new clause rather than create further unfairness in the system.
Regarding new clause 11, I re-emphasise that we will not speculate on the findings or any potential outcomes of the independent review. All recommendations will be considered when the independent review concludes. It would not be appropriate of the Department to commit to this new auditing requirement until that has happened, when we can take a holistic view of carer’s allowance and how DWP uses data. Nevertheless, it is helpful to set out how DWP currently uses data to verify eligibility for carer’s allowance. Verification of earnings and pensions alerts were introduced to carer’s allowance in October 2018 as part of a wider strategy to identify data sources, to verify information provided by the claimant, or to identify if information has not been provided by the claimant. Like all data we use for that, it is not intended to replace the legal requirement of a claimant to provide information that may change their entitlement to social security.
VEP alerts arise from HMRC payroll data. The alert service provides a notification of new earnings or pensions as they come into payment, or if amounts change during the life of the claim. The Department uses business rules to prioritise those alerts, based on data provided by the real-time earnings system. Since 2019, we have actioned around 50% of the alerts received in the Department as part of our focus on reducing the risk and level of overpayments. Having secured additional funding in the one-year spending review, we will be deploying additional resource in 2025-26,to action the alerts received from HMRC as quickly as possible. The Department is also testing an approach of using text messages to remind customers of the need to report changes in their circumstances.
Finally, I emphasise that the use of VEP alerts does not replace human decision making. If the Department processes an alert that highlights a change in earnings and a customer has not reported the change, DWP officials will contact the customer to confirm details have changed. If any overpayment is identified, it will be referred to debt-recovery teams. DWP remains committed to working with anyone who is struggling with their repayment terms, and will always look to negotiate sustainable and affordable repayment plans.
In the light of the information I have set out, and the ongoing work of the carer’s allowance independent review, I urge the hon. Member for Torbay to withdraw the proposed new clause.
Rebecca Smith
Liberal Democrat new clause 10 would delay any payments being taken from people who the Government think owe repayments on carer’s allowance until the independent review into carer’s allowance overpayments has been published and fully implemented. Liberal Democrat new clause 11 would provide for an audit of algorithmic systems used in relation to carer’s allowance overpayments. It would require that, if any audit identified significant inaccuracies, unfairness or biases in any algorithmic system, the Secretary of State must, within 30 days of the publication of the report outlining these findings, present an action plan to Parliament that outlines the steps the Government intend to take to discuss the identified issues. I am interested to know why the Liberal Democrats are singling out carer’s allowance for this treatment—namely, the review of the algorithmic systems—rather than any other allowance or benefits. Is there a reason for that?
Liberal Democrat amendment 32 is a commencement block. It specifies that no part of the Bill may come into force until the recommendations of a report commissioned under the clause “Recovery of overpayments of Carer’s Allowance” have been implemented. We would suggest that there is more holistic information that should be made public before the Bill can be commenced, and that the focus on carer’s allowance is in danger of missing the bigger picture. For example, we need to see the codes of practice, and we need to know precisely how the banks will deliver their responsibilities under the Bill. I would suggest that those things, which are sadly not yet available to the Committee as we scrutinise the legislation, and that has greatly hindered us, would provide a much more holistic assessment of whether the Government are ready to implement the Bill than the report on recovering overpayments of carer’s allowance. Would the Liberal Democrats consider an amendment at a later stage that goes wider than that?
Andrew Western
I contend that amendment 32 is simply disproportionate given the wide range of benefits that the Bill is expected to deliver to address fraud and error, not just in the social security system but in the public sector more widely. It is essential that all of Government have access to the capabilities and tools required to stop fraudsters stealing from the taxpayer. Tens of billions of pounds are being lost to public sector fraud. These losses are unacceptable, and waste enormous sums of public money, which could be put to good use. Delaying the Bill coming into force will risk £1.5 billion of savings over the next five years. These have been certified by the Office for Budget Responsibility. The Government made a manifesto commitment that we would safeguard taxpayers’ money and not tolerate fraud or waste anywhere in public services. The Bill delivers on that commitment, and delaying its delivery is unfair on taxpayers, who deserve to have confidence that money spent by Government is reaching those who need it, and not those who exploit the system.
Secondly—we have already discussed this point at length—I remind Members that the Bill introduces new, important safeguards, including provisions for independent oversight and reporting mechanisms, to ensure the proportionate and effective use of the powers. New codes of practice will be consulted on and published to govern how new measures will be exercised in more detail. That will include details of further protections. There will be new rights of review and appeal in both parts of the Bill to ensure that there are opportunities to challenge the Government’s approach. A human being will always be involved in decisions about further investigation or the recovery of any debt.
Finally, I return to my earlier point: data and information sharing are crucial when we look at fraud and error. For example, the eligibility verification measure, while it will not be applied to carer’s allowance itself, will improve the DWP’s access to important data to help to verify entitlements, ensure that payments are correct, and prevent the build-up of overpayments. That will enable the DWP to be tough on those who cheat the benefits system and fair to claimants who make genuine mistakes. It is vital that the DWP is equipped with the right tools, and delaying this Bill will only delay these benefits. In the light of that, I hope that Members will not press the amendment.
Steve Darling
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 13
Liability orders
“(1) Where—
(a) a person has been found guilty of an offence under section 1 or section 11 of the Fraud Act 2006, or the offence at common law of conspiracy to defraud,
(b) that offence relates to fraud committed against a public authority, and
(c) the person has not paid the required penalties or not made the required repayments,
the Secretary of State may apply to a magistrates’ court or, in Scotland, to the sheriff, for an order (“a liability order”) against the liable person.
(2) Where the Secretary of State applies for a liability order, the magistrates’ court or (as the case may be) sheriff shall make the order if satisfied that the payments in question have become payable by the liable person and have not been paid.
(3) The Secretary of State may make regulations in relation to England and Wales—
(a) prescribing the procedure to be followed in dealing with an application by the Secretary of State for a liability order;
(b) prescribing the form and contents of a liability order; and
(c) providing that where a magistrates’ court has made a liability order, the person against whom it is made shall, during such time as the amount in respect of which the order was made remains wholly or partly unpaid, be under a duty to supply relevant information to the Secretary of State.
(4) Where a liability order has been made against a person (“the liable person”), the Secretary of State may use the procedure in Schedule 12 to the Tribunals, Courts and Enforcement Act 2007 (taking control of goods) to recover the amount in respect of which the order was made, to the extent that it remains unpaid.”—(Rebecca Smith.)
Brought up, and read the First time.
Rebecca Smith
I beg to move, That the clause be read a Second time.
Our new clause would provide that, where someone has been found guilty of fraud or conspiracy to defraud and not made the required payments, the Secretary of State can apply for a liability order. It further provides that, where a liability order has been made against a person, the Secretary of State may use the procedure in schedule 12 to the Tribunals, Courts and Enforcement Act 2007, on taking control of goods, to recover the amount in respect of which the order was made, to the extent that it remains unpaid.
The new clause is intended to give the DWP powers to apply to the courts to seize assets where fraud is probable, with the same burden of proof as for cash seizures. It would bring the DWP into line with the Child Maintenance Service. I know that we have had some debate on the matter, so this is probably more of a probing or tidying-up amendment than anything else, but it would be useful to have that said explicitly. It goes without saying that, if the Minister does not intend to support the new clause, I will be interested to know why. If the DWP is serious about recovering money lost to fraud and the person liable is not making the required repayments, why should the DWP not be able to apply to seize their assets?
Georgia Gould
This is similar to the previous new clause we discussed. We have a lot of sympathy with the points set out. We want to ensure that we recover money, whether it is fraud against the public sector more widely or fraud against the DWP, but we believe that that is already covered in the Bill and I will run through why.
Clause 16 clarifies that the PSFA is able to seek alternative civil recovery through the civil courts, in addition to the direct deduction orders and deduction from earnings orders in the Bill. It confirms that the PSFA will be able to apply to the county court for a recovery order. That is an order providing that the payable amount is recoverable
“under section 85 of the County Courts Act 1984, or…otherwise as if it were payable under an order of the court.”
Section 85 of the County Courts Act also refers to the use of the procedure in schedule 12 to the Tribunals, Courts and Enforcement Act 2007 to recover the money. That would enable the PSFA to seek enforcement of a debt by applying for a warrant of control in the county court, enabling a court enforcement officer to seize and sell goods to satisfy the debt. That ensures that the PSFA is able to pursue recovery through the most appropriate and effective mechanisms. New clause 13 is therefore already provided through the Bill for the PSFA and through existing legislation for the DWP—section 71 and section 71ZE of the Social Security Administration Act 1992 to be specific—allowing them operational flexibility to recover money in the most effective and efficient way to return money to the public purse. An amendment is not required to do that.
Rebecca Smith
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 14
Inclusion of systems within the Algorithmic Transparency Reporting Standard
“(1) For the purposes of this section, ‘system’ means—
(a) algorithms, algorithmic tools, and systems; and
(b) artificial intelligence, including machine learning
provided that they are used in fulfilling the purposes of this Act.
(2) Where at any time after the passage of this Act, the use of any system is—
(a) commenced;
(b) amended; or
(c) discontinued
the Minister must, as soon as reasonably practicable, accordingly include information about the system in the Algorithmic Transparency Reporting Standard.” —(John Milne.)
This new clause would require the use of algorithms, algorithmic tools, and systems, and artificial intelligence, including machine learning, to be included within the Algorithmic Transparency Reporting Standard.
Brought up, and read the First time.
John Milne
I beg to move, That the clause be read a Second time.
The new clause would require that the use of algorithms, algorithmic tools and systems, and artificial intelligence, including machine learning, should be included within the algorithmic transparency reporting standard. That standard, established by the Government, is supposed to be mandatory for all Government Departments. However, last November, The Guardian reported that not a single Whitehall Department has registered the use of AI systems since it was made mandatory.
Throughout debate on this issue, the Government have consistently downplayed the risk of using AI to trawl for suspect claimants, but if it really is that simple, why have so many organisations come out with concerns and opposition? That includes Age UK, ATD—All Together in Dignity—Fourth World, Amnesty International, Campaign for Disability Justice, Child Poverty Action Group, Defend Digital Me and Difference North East. I could go on: I have half a page, which I will spare the Committee from, listing organisations that have expressed concern. It is quite a roll call.
Governments can and will get things wrong. History tells us that if it tells us anything. In June 2024, a Guardian investigation revealed that a DWP algorithm had wrongly flagged 200,000 people for possible fraud and error; it found that two thirds of housing benefit claims marked as high risk in the previous three years were in fact legitimate, but thousands of UK households every month had their housing benefit claims wrongly investigated. Overall, about £4.4 million was wasted on officials carrying out checks that did not save any money. We know that more mistakes will happen, no matter how hard we try to avoid them. I therefore ask the Minister to support the insertion of new clause 14 as a small measure of defence against future institutional failings.
Rebecca Smith
As we have heard, Liberal Democrat new clause 14 would require the use of algorithms, algorithmic tools, and systems, and artificial intelligence, including machine learning, to be included in the algorithmic transparency reporting standard. I have obviously just heard the comments of the hon. Member for Horsham, but I would be interested to know precisely what the Liberal Democrats are aiming to achieve with this new clause and how such reporting would better enable the Government to crack down on fraud and error. Is that the intention behind the new clause?
Andrew Western
I share the support expressed by the hon. Member for Horsham for the algorithmic transparency recording standard as a framework for capturing information about algorithmic tools, including AI systems, and ensuring that public sector bodies openly publish information about the algorithmic tools used in decision-making processes that affect members of the public. However, I do not think the new clause is a necessary addition to the Bill, and I will explain why.
First, all central Government Departments, including the DWP and the Cabinet Office, are already required to comply with the standard as appropriate. We are committed to ensuring that there is appropriate public scrutiny of algorithmic tools that have a significant influence on a decision-making process with public effect, or that directly interact with the public. We have followed and will continue to follow the guidance published by the Department for Science, Innovation and Technology on this to ensure the necessary transparency and scrutiny.
Secondly, I remind the Committee that although the DWP and PSFA are improving their access to relevant data through the Bill, we are not introducing any new use of machine learning or automated decision making in the Bill measures. I can continue to assure the House that, as is the case now, a human will always be involved in decisions that affect benefit entitlement.
Thirdly, although I do not wish to labour the point yet again, I remind the Committee that the Bill introduces new and important safeguards, including reporting mechanisms and independent oversight in the Bill, demonstrating our commitment to transparency and ensuring that the powers will be used proportionately and effectively. The DWP takes data protection very seriously and will always comply with data protection law. Any information obtained will be kept confidential and secure, in line with GDPR.
John Milne
I am content to beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 15
Offence of encouraging or assisting others to commit fraud
“(1) The Social Security Administration Act 1992 is amended as follows.
(2) In section 111A (Dishonest representation for obtaining benefit etc), after subsection (1G) insert—
‘(1H) A person commits an offence if they—
(a) encourage or assist another person to commit an offence under this section, or
(b) provide guidance on how to commit an offence under this section.’
(3) In section 112 (False representations for obtaining benefit etc), after subsection (1F) insert—
‘(1G) A person commits an offence if they—
(a) encourage or assist another person to commit an offence under this section, or
(b) provide guidance on how to commit an offence under this section.’”—(Rebecca Smith.)
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Rebecca Smith
I beg to move, That the clause be read a Second time.
New clause 16 would require the Secretary of State to conduct a review of whistleblowing processes in relation to fraud in the public sector within one year of the Bill passing. The Opposition would like the review to include the appropriateness and efficacy of existing whistleblowing processes, the barriers to reporting fraud, the reasons for the under-reporting of fraud, and recommendations for change.
The Committee has previously discussed the 2023 National Audit Office report that highlighted the difficulties with whistleblowing within the public sector, particularly in respect of whistleblowing on senior colleagues. The NAO also highlighted that of the public sector whistleblowing disclosures it received in 2023-24, 12% related to fraud. I did not get a particularly clear answer from the Minister about the safeguards that have been put in place to ensure that junior civil servants are able to raise concerns about more senior members of staff, so I am interested to see if there is more to be said.
It is a serious issue. One of the reasons I was interested in tabling this new clause is that, as a junior member of staff at a local authority, I saw this happen. I was in a situation where two colleagues were defrauding the local housing authority, and at that stage as a 21-year-old I did not feel able to do anything about it. That is one of the biggest regrets of my life. Having worked significantly in housing since, the fact that I was not able to call them out for essentially purchasing a council house that they were no longer living in, makes me feel that this safeguard —ensuring that Government Departments’ houses are in order as the legislation goes forward—is particularly vital.
John Smart, who sits on the PSFA’s advisory panel, raised the example of the US, which has whistleblower reward legislation in place that is effective at flushing out issues affecting payments made by the Government. The legislation flushes out fraud by incentivising whistleblowers to blow the whistle, so to speak. He recommended that the Government consider such legislation, so could the Minister inform the Committee whether the Government have looked into that option? Would it be possible for us to learn from that legislation? Could the Government consider such legislation in the future, and if not, why not?
Georgia Gould
I thank the hon. Lady for raising the critical issue of whistleblowing. I assure her of how seriously the Under-Secretary of State for Work and Pensions—my hon. Friend the Member for Stretford and Urmston—myself, and both Secretaries of State take the issue of whistleblowing. I hope, as I set out our responses to the NAO report and our wider work, to offer the reassurance that the Opposition are looking for.
When it comes to internal and external fraud against the public sector, Government Departments are responsible for their own whistleblowing arrangements and for overseeing arrangements in their arm’s length bodies. For example, the Department for Business and Trade publishes and regularly updates its guidance, “Whistleblowing: list of prescribed people and bodies”, which details who individuals can raise a concern with. The list comprises bodies and individuals to whom making a disclosure qualifies the individual who makes the disclosure for legal protections under the Employment Rights Act 1996—for instance, protection against being dismissed by their employer for the disclosure.
Whistleblowers can report concerns about public sector fraud to bodies such as the NAO’s Comptroller and Auditor General, the director of the Serious Fraud Office, the Auditors General for Wales and for Scotland, the NHS Counter Fraud Authority and various other bodies listed on gov.uk. The NAO report that the hon. Lady referred to set out that between 2019 and 2022 fraud one of the most common concerns raised—I think it accounted for 40% of concerns.
On the review of the existing processes, the key findings of the recent NAO publication related to the need to increase awareness of the channels for whistleblowing, to improve the experience of whistleblowers and to ensure that lessons are learned, as the hon. Lady set out. In the light of the NAO report, and with the intention of opening up as many avenues as possible for the reporting of public sector fraud, the PSFA will explore with the Department for Business and Trade whether it would be appropriate to add the PSFA to the list of prescribed organisations. That would go alongside the existing ability to raise fraud within a public sector body or Department. We will also use the findings of the report, as well as the NAO’s good practice guide to whistleblowing in the civil service, to inform our approach.
The DWP has established processes by which members of the public and staff can report suspected benefit fraud. Members of the public can report fraud online at gov.uk, by phone or by post, while DWP staff follow clear internal guidance and processes. Given the intent to maintain the focus of this legislation, the recent work by the National Audit Office, the existing DWP processes and the steps the PSFA is taking to continue to improve the whistleblowing offer for public sector fraud, I will resist new clause 16.
Rebecca Smith
I appreciate the Minister’s response. We will withdraw the new clause, but I urge her to go back and look at what more can be done. I appreciate that the PSFA might come in as a prescribed organisation, but I am particularly concerned about how we bridge the gap and enable more junior civil servants to blow the whistle in relation to senior colleagues. Ultimately, that was the focus of the NAO report. If there is a way to look at that ahead of Report stage, I would be grateful. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 17
Duty to consider domestic abuse risk to holders of joint accounts
“(1) Before any direct deduction order under Schedule 5 is made, the Secretary of State has a duty to consider its effect on any person (‘P’) who—
(a) is a victim of domestic abuse, or
(b) the Secretary of State reasonably believes to be at risk of domestic abuse,
where P shares a joint account with a liable person believed to be the perpetrator or potential perpetrator of domestic abuse.
(2) In this section ‘domestic abuse’ has the meaning given by section 1 of the Domestic Abuse Act 2021.”—(Steve Darling.)
Brought up, and read the First time.
Steve Darling
I beg to move, That the clause be read a Second time.
I start by acknowledging the hard work of Surviving Economic Abuse in this policy area. I thank that charity for its briefing, which I am sure it has shared with all Committee members. The charity and the Liberal Democrats are keen to make sure that domestic abuse, particularly where it plays out in relation to joint accounts, is on the face of the Bill, so that it is taken very seriously.
I can almost hear the Minister’s voice saying that DWP officers are well trained to deal with vulnerable claimants, but it is extremely important to put domestic abuse on the face of the Bill. Domestic abuse is a very wicked issue in my Torbay constituency, and I am sad to say that Torbay is not alone in it being a serious challenge in people’s households. I hope the Government will take this seriously and support the new clause, so we would like to press it to a vote in due course.
Rebecca Smith
The Conservatives—the official Opposition—share the Liberal Democrats’ view that it is vital that we use different Departments across Government to tackle domestic abuse and domestic violence. We have a really strong track record of doing that in government.
In principle, the new clause seems like a good idea. I am conscious that we need to ensure that the Bill does not exacerbate or create problems for victims and put them even more at risk. I have done a lot of work on violence against women and girls away from this place, and I am conscious of how tricky it can be to prove some of these things. I wonder whether there might be other ways to achieve the same outcome. I assume that is why the Government are not able to support the new clause.
The new clause includes language such as “potential” and “believed to be”. My gentle challenge is about whether it could be worded differently, as we go forward to other stages, to make it more achievable and deliverable, and something that would have a place in the Bill. As it stands, I am not sure that would be the case, but I am interested to see this issue debated further, because the official Opposition share the commitment to tackling domestic abuse and domestic violence.
Andrew Western
We have reached the stage in Committee at which the hon. Member for Torbay can second-guess my comments. He will be as pleased as I am that this is the last of the new clauses for debate, but it is a very serious one.
New clause 17 seeks to place a duty on Secretary of State to consider the impact of a proposed direct deduction order where a person is a victim of domestic abuse, or officials reasonably believe they are at risk of domestic abuse, and they share an account with a perpetrator of that abuse. I share the hon. Member for Torbay’s view that, where the new recovery powers are exercised, there should be a consideration of whether there is evidence of domestic abuse. However, I do not believe the new clause reflects the right approach. The DWP understands the importance of supporting victims and survivors of domestic abuse, and has existing guidance, processes and operational best practice for supporting them.
The new clause would apply to both debtors and non-debtors, and would not require the DWP to take any steps to identify possible victims. Subsection (1)(a) would place a duty on officials to consider the impact any time a person was a victim, even when the DWP did not and could not have known that that was the case. Subsection (1)(b) would imply a duty to assess whether there was reason to believe the person was at risk of domestic abuse but, as the hon. Member for South West Devon suggested, in many cases the DWP will not be in a position to make that assessment. That would put officials in a difficult, if not impossible, position.
As the direct deduction powers will be used as a last resort where multiple attempts to engage with the debtor to arrange a voluntary, affordable and sustainable repayment plan have failed, we anticipate that the DWP will know very little about the debtor’s current circumstances, unless it had been made aware previously or there were clear identifiable risk factors. We are working closely with charities, some of which the hon. Member for Torbay will have heard from, to help to identify those risks, as I will outline.
Where a joint account holder could be at risk of domestic abuse but is not the debtor, we are unlikely to have ever had direct dealings with them prior to the power being used. Unless we were directly notified, it is unlikely we would have the information necessary to form the reasonable belief that they were at risk, and much less likely that we could identify all the cases where the person was experiencing abuse. I do not, therefore, agree that a placing a legal duty on officials in this way is the right approach.
We are committed to continuing to support victims of domestic abuse whenever they interact with the Department, which is why we are working with charities such as Surviving Economic Abuse, which is dedicated to advocating for women whose partner has controlled their ability to acquire, use and maintain economic resources. SEA is supporting the drafting of the code of practice to ensure that robust safeguards are in place and to encourage engagement specifically from those who are vulnerable, including victims of domestic abuse. Although SEA works with women, the principles will apply to all victims and survivors of domestic abuse.
Frontline debt management staff already receive training for their role, including on assessing affordability, discussing hardship, and identifying and dealing with vulnerable customers. As we have heard, a specialist debt enforcement team will exercise the new recovery powers, and it will be governed by a code of practice. As explained, we will consult on the draft code of practice, and I welcome further views as part of the wider public consultation.
Finally, I note that paragraph 6(1)(b) of schedule 5 already imposes a broad duty on the Secretary of State to ensure that the amount of any deduction is
“fair in all the circumstances.”
That would include consideration of the impact on a victim of domestic abuse, as the hon. Member for Torbay seeks in the new clause, where the relevant context and circumstances are known to the Department. I hope that reassures the hon. Member that his concerns are already addressed in the Bill, and that the DWP takes domestic abuse seriously and will continue to do so when exercising the new recovery powers.
Steve Darling
I would like to press the new clause to a vote.
Question put, That the clause be read a Second time.
Georgia Gould
This is the final group of clauses that the Committee will consider. I give massive thanks to the Committee for our constructive dialogue, which I am sure will continue—I look forward to a long afternoon and Thursday discussing these final clauses.
Clause 99 covers how the Bill will be applied and limited by setting out the retrospective effect of the new powers, and makes some technical amendments to the Limitation Act 1980. There is a significant policy change in the clause, which is the extension of the existing six-year limit for civil claims relating to covid frauds. I think the Committee will agree that is critical. Although the application and limitation of the clause covers the whole Bill, and the powers can be used on existing cases, retrospective effect does not apply for clauses 96 and 97, which relate to non-benefit payment administrative penalties.
Subsection (3) of clause 99 sets out that the time-limit change applies to amounts that an England and Wales public authority is entitled to claim from a person as a result of a fraud the person carried out. Subsection (5) clarifies what is meant by an England and Wales public authority, and explains that Scottish and Welsh devolved authorities are not included. Subsection (7) makes technical amendments to section 38(11) of the Limitation Act 1980.
Clause 100 enables the Secretary of State for Work and Pensions and the Minister for the Cabinet Office to ensure that the Bill works alongside all existing legislation. As is usual for Bills that may have provisions consequential for other Acts of Parliament, the power allows the Secretary of State and the Minister to amend other legislation to ensure that the Bill works effectively with existing Acts of Parliament.
Clause 101 recognises that the Bill requires a money resolution, primarily because it confers new functions on the Minister for the Cabinet Office and the Department for Work and Pensions.
Clause 102 sets out the Bill’s territorial extent, while annex A in the accompanying explanatory notes provides a full breakdown of the territorial extent and application of its measures. The provisions in part 1 apply to England and Wales. Legislative consent is required for Wales for some parts of the part 1 provisions. The provisions in part 2 apply to England, Wales and Scotland in relation to reserved matters.
As the Committee is aware, the UK Government do not generally legislate on devolved matters without the consent of the relevant devolved Governments. We have written to our counterparts in Scotland and Wales, and engagement with both remains ongoing, to seek legislative consent from Wales on the part 1 provisions that interact with Welsh competence and from Scotland on the part 2 provisions that interact with Scottish competence.
Clause 103 is required to enable the provisions in the Bill to be implemented. It sets out how the Bill’s provisions will be commenced.
Finally, clause 104 is straightforward and confirms that the short title of the Act will be the Public Authorities (Fraud, Error and Recovery) Act 2025, to summarise the intent of the Bill captured in the long title. Having outlined the main provisions in clauses 99 to 104, I commend them to the Committee.
Rebecca Smith
The good news is that the Minister has answered some of my questions, particularly in respect of clause 99 and the extension of the retrospective time limits. Clause 100 is a standard Henry VIII power to make consequential provision as a result of the legislation; does the Minister envisage that the power will need to be used frequently? Clauses 101 to 104 are standard provisions and we do not have any substantive comments to make on them.
Georgia Gould
The Henry VIII power is to ensure that any other legislation is in line with this legislation. We do not expect it to be used on lots of occasions, but it will be used on some. We welcome the Opposition’s support for the extension to the limit for investigating covid fraud. I thank the Committee again for its work on the Bill, which will ensure that we take action against fraud wherever it occurs.
Question put and agreed to.
Clause 99 accordingly ordered to stand part of the Bill.
Clauses 100 to 104 ordered to stand part of the Bill.
Question proposed, That the Chair do report the Bill, as amended, to the House.
Andrew Western
I place on the record my thanks to you, Mr Western, and all the other Chairs who have supported and guided us through the Bill. I thank the Clerks and officials from the Cabinet Office and DWP for their support. I also thank my co-pilot, the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Queen’s Park and Maida Vale; the Opposition spokespersons; and all Committee members for their input. I commend the Bill to the Committee.
Question put and agreed to.
Bill, as amended, accordingly to be reported.
Border Security, Asylum and Immigration Bill (Twelfth sitting)
(2 days, 11 hours ago)
Public Bill CommitteesRead Hansard Text Read Debate Ministerial Extracts
The Committee divided: - Ayes: 3 / Noes: 13 - Question accordingly negatived.
The Committee divided: - Ayes: 3 / Noes: 13 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 14 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 14 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 14 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 14 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 14 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 14 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 12 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 12 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 12 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 12 - Question accordingly negatived.
The Committee divided: - Ayes: 2 / Noes: 12 - Question accordingly negatived.
Susan Murray (Mid Dunbartonshire) (LD)
I beg to move, that the clause be read a Second time.
It is a pleasure to work under your chairmanship, Dr Murrison. The new clause would enable replacements of large portions of the Nationality and Borders Act 2022 —in particular, sections on asylum, immigration control, age assessments and modern slavery—to ensure the upholding of the refugee convention, to provide for safe and legal routes to sanctuary for refugees and to help prevent dangerous channel crossings.
Matt Vickers (Stockton West) (Con)
Liberal Democrat new clause 27 seeks to repeal provisions in the Nationality and Borders Act 2022 passed by the previous Conservative Government. By attempting to repeal section 29 of the Act, the Liberal Democrats are seeking to prevent the Government from removing people, including criminals, to a safe third country.
Rewind back to 2022 when 45,000 people crammed into small boats, flimsy rafts teetering on the channel’s unforgiving waves—a swarm, spurred by the hope of slipping through our borders, hammering coastal towns and stretching security to its limits.
The Minister for Border Security and Asylum (Dame Angela Eagle)
Did the hon. Gentleman really mean “swarm” in that context? That is quite emotive language.
Matt Vickers
Well, hot air is required in this room this afternoon, and I intend to provide it.
We fought back with the Nationality and Borders Act third-country removals, which helped the Government to deter crossings by 36% in 2023 from 45,000 to under 29,000—not by chance, but by design, sending a message to traffickers and migrants alike that Britain is no soft touch or guaranteed prize. Now, the Liberal Democrats barge in with new clause 27, desperate to repeal section 29 to shred that deterrent and plunge us back into chaos, flinging the channel wide open not just to the weary but to every chancer or criminal. That is not tweaking policy; it is torching a firewall, inviting all those to Dover’s cliffs and Deal’s shores and erasing every inch of progress that we have clawed from the crisis. The Lib Dems owe us hard answers. How many boats—50,000 or 60,000?
The Albania deal delivered a masterstroke of border control. That pragmatic triumph has turned a torrent of illegal crossings into a trickle through sheer diplomatic grit. Back in 2022, Albanians dominated the small boats surge. A 12,000-strong, relentless wave of young men were lured by traffickers with promises of easy UK entry for £3,000, clogging Dover’s processing centres and fuelling tabloid headlines of chaos. Then came our 2023 pact with Tirana—a no-nonsense agreement that flipped the script with fast-track returns, joint police operations and a clear signal: Albania is safe and you are going back.
By 2024, the results were staggering. Weekly flights were whisking deportees home, with each jet a nail in the coffin of the smuggling networks that once thrived on our porous borders. That was not luck or loud threats but cold, hard execution, bolstered by UK-funded cameras on the Albania-Kosovo frontier and Albanian officers embedded in Dover.
Chris Murray (Edinburgh East and Musselburgh) (Lab)
I think that the hon. Gentleman is somewhat overstating the impact of the Albania policy. After the initial agreement was signed, we saw a massive spike in numbers coming from Albania, and the numbers had already started to fall before the communiqué was signed. The correlation and causation arguments that he is making on the Albania scheme do not add up at all.
Matt Vickers
What is effective? The deal reduced the number of people coming from Albania by more than 90%. If we could get a few more agreements like that, we would be on the way—that would be huge progress. The Albania deal represented huge progress; to suggest otherwise is wrong. It choked off routes before boats had even launched and had a real impact.
Chris Murray
Would the hon. Gentleman at least accept that the Albania returns were largely due to large numbers of foreign national offenders, who are a completely different category of people from those we are talking about in either this clause or this Bill?
Matt Vickers
We would want to return foreign national offenders; that is really positive. But the number of people choosing to cross because of that deterrent effect went down by not 10% or 20%, but by more than 90%. More than 90% fewer people arrived from Albania in small boats. That is huge progress. If we can replicate that elsewhere, I will be a very happy boy because we would see a huge impact on those crossings across the piece.
New clause 27 is hellbent on repealing that backbone, oblivious to how crossings from Albanians were successfully slashed, while the Rwanda threat kept smugglers guessing. If the Liberal Democrats prevail, every bilateral deal will be on the chopping block. Imagine Albanian numbers roaring back to 12,000, with other current surges unchecked. That is not progress; it is sabotage—a reckless bid to unravel a system that is finally biting back at the chaos. Do the Liberal Democrats not want to be able to remove people from this country who have entered illegally? Do they believe that any national of a safe country should be able to seek asylum in the UK? Can Liberal Democrat Members explain why that would not create a massive pull factor and encourage people to cross the channel in small boats?
The Liberal Democrats are also seeking to repeal sections 15 to 17 of the Nationality and Borders Act 2022, which specify that the Secretary of State must declare an asylum claim made by a person who is a national of an EU member state inadmissible. Why would the Liberal Democrats believe that anyone from the EU needs to claim asylum here? Picture this scene, which is so utterly ridiculous that it strains the bounds of credulity: an EU citizen, perhaps some laid-back Amsterdamer, pedalling along the city’s picturesque canals one sunny afternoon, tulips nodding in the breeze, then suddenly deciding to chuck it all, hop on a ferry and pitch up on Dover’s pebbled shores, requesting asylum, as if the Netherlands’ orderly bike lanes and windmill-dotted horizons had morphed into a scene from—
Tom Hayes (Bournemouth East) (Lab)
We are witnessing some particularly theatrical prose, perhaps for the first time. Has Boris Johnson got a new job as the hon. Gentleman’s speechwriter?
Matt Vickers
His writing seems to be going quite well at the moment. I do not know that I have the cash for him.
What I have described is not asylum. We cannot pretend that the EU’s 27 nations and its vast tapestry of safe, stable and prosperous lands—we can take our pick of France, Italy, Spain, Sweden and so on, each a bastion of peace and plenty—somehow warrant the same desperate lifeline that we reserve for those fleeing real and genuine chaos. This is the same organisation that the Liberal Democrats supposedly want to build closer ties with. They also want the UK to grant asylum to people who come to this country having already been in a country where they have claimed and been granted asylum. Why are the Liberal Democrats encouraging people to cross the channel when they already have asylum or can claim asylum in a safe third country?
Just like the Labour Government, the Liberal Democrats want to remove sections of the Nationality and Borders Act 2022 that allow local and public authorities to conduct an age assessment on an age-disputed person. As we discussed before when the SNP did not wish those who claim to be a child to be treated as an adult, every European country apart from ours uses scientific age assessment techniques such as an X-ray of the wrist. As we have said, there are also other methods. More than 50% of those claiming to be children were found to be adults after an age assessment in the quarter before the election. Without a scientific age assessment method, it is very hard to determine age. Given the horror stories in this area, why do Liberal Democrats want to put the people of this country at risk, and blindly allow unverified people into the UK?
Let us now talk about a nightmare unfolding right under our noses: one that the Liberal Democrats seem hellbent on making worse. In the first quarter of 2021 alone, 560 adults—grown men with stubble, receding hairlines and years behind them—had the gall to pose as kids, slipping through the cracks until scientific age checks, such as wrist X-rays and dental scans that every sensible European nation uses, caught them red handed and stopped them cold.
The Lib Dems’ new clause 27 would axe those checks and rip out the one tool keeping us from dumping people who are 25 years old or even older into classrooms alongside children. That is not some abstract risk. It has happened and it is real; it means men in their 20s sitting at desks meant for teens, all because we have let sentiment trump science. That would not protect children, but endanger them—a reckless gamble that would turn schools into hunting grounds and parents into nervous wrecks, all so the Lib Dems can pat themselves on the back for being compassionate. If they get their way, every classroom will have a question mark. How many 25-year-olds will slip through before the damage is done?
What do the Liberal Democrats believe should happen if the authorities believe a migrant who is claiming to be under 18 is actually an adult? Do they believe that such people should be placed in schools with schoolchildren? Again, it seems as though the Liberal Democrats want to strip the Government of any power to control who comes to the country. That would see net migration drastically increase.
The issue cuts deeper than policy, however; it is about what people expect, and the Liberal Democrats’ new clause pulls hard against that grain. Voters have signalled what they want loud and clear, with 68%—nearly seven in 10—backing tougher border controls in surveys: a call echoing from Dover to Folkestone, where residents live with the reality of arrivals day by day. That is not a passing opinion; it is a steady demand—rooted in years of debate, from the 2016 Brexit vote to the 2019 landslide—for a system that prioritises their say.
Dame Angela Eagle
I do not know what the hon. Gentleman had for lunch, but perhaps we should find out and get some of it ourselves. We can then all compete with the poet laureate and the virtuoso performance that we have just heard.
I am going to talk about the new clause, however, which is in respect of the Nationality and Borders Act 2022. The hon. Member for Mid Dunbartonshire is proposing that numerous sections of the 2022 Act be repealed under the Bill.
I should start by making it clear that we are determined to restore order to the asylum system, so that it operates swiftly, firmly and fairly, and ensures that the rules are properly enforced. That is a financial necessity to deal with the backlogs that we have inherited—the permit backlog in particular, but also others, especially in the appeals space—so that the costs do not continue to mount up at the expense of the taxpayer. Getting the system moving again is an important part of what we have been doing.
Following the election, the Home Secretary acted rapidly to change the law to remove the retrospective application of the Illegal Migration Act 2023, which allowed decision makers to decide asylum claims from individuals who arrived in the UK from 7 March 2023. Previously, there was a ban on that, because of the duty to remove, which was never going to be sensibly put into effect.
I am not going to speak to every section of the Nationality and Borders Act, but the hon. Member for Mid Dunbartonshire wants us to repeal very large chunks of the Act under the new clause. I will mention only a few, and I hope that she will forgive me for not talking about every section.
The introduction of the national age assessment board, for example, in March 2023, relies on a piece of the Nationality and Borders Act that the hon. Lady wishes to repeal. In the interim, since that Act has come into being, we have introduced the national age assessment board and made it available across the country. It continues to offer significant improvement to our processes for assessing age, including creating greater consistency in age assessment practices, which can be very inconsistent in the practical delivery of Merton-compliant assessments in different local authorities—some are more experienced and some better at it than others. The national age assessment board creates a standard and a bar below which it is hard to go. It sets important standards in age assessment, improves quality and ensures that ages are recorded correctly for immigration purposes.
The Nationality and Borders Act also placed protections and support under the Council of Europe convention on action against trafficking in human beings on a legislative footing for the first time in the UK. That includes the right to a recovery period in the national referral mechanism, during which potential victims of modern slavery and trafficking are eligible for support and are protected from removal from the UK. The Act provides the means to disqualify individuals—I suspect that this may be the bit that the hon. Member for Mid Dunbartonshire objects to—from protections or support on the grounds of public order or bad faith. However, that is in line with article 13 of the convention; that part of the Nationality and Borders Act put the convention into UK law. I am surprised she is suggesting that we should remove it.
The Act also sets out the circumstances in which confirmed victims of slavery and trafficking may be granted temporary permission to stay in the UK. The Government will be launching a public consultation, before summer recess, on how we can improve the process of identifying victims of modern slavery. We will provide details on that consultation in due course.
Susan Murray
I thank the Minister for her clear outline. The Liberal Democrats want to enable the replacement of large portions of the Nationality and Borders Act and ensure that we uphold the refugee convention. We wish to push the new clause to a vote.
Question put, That the clause be read a Second time.
Susan Murray
I beg to move, That the clause be read a Second time.
This new clause would make provision for leave to enter or remain the UK to be granted to the family members of refugees and of people granted humanitarian protection. Through the clause the Liberal Democrats seek to support refugee family reunion and to help people to integrate into the community, learn the language, make a home and work to contribute to society, exactly as the hon. Member for Edinburgh East and Musselburgh discussed.
Matt Vickers
Liberal Democrat new clause 29 requires that within six months of the date on which this Act is passed, the Secretary of State should lay before Parliament provision for leave to enter or remain in the UK to be granted to family members of people granted refugee status and of people granted humanitarian protection. In the new clause, family members include: a person’s parent, including adoptive parent; their spouse, civil partner or unmarried partner; and their child or sibling, including their adopted child or adoptive sibling, who is either under 18 or under 25, having been under 18 or unmarried
“at the time the person granted asylum left their country of residence to seek asylum”.
Further, it can be taken to mean
“other persons as the Secretary of State may determine, having regard to…the importance of maintaining family unity…the best interests of a child…the physical, emotional, psychological or financial dependency between a person granted refugee status or humanitarian protection and another person.”
If those provisions were not already incredibly vague, the Liberal Democrats have included a proposal that other persons can be determined by the Secretary of State. That could obviously result in a huge number of spurious claims made by family members who will say that they have a dependency on another person so they must be allowed to come to the UK under the provision. We already have judges completely stretching the definition of “right to family life” under article 8 of the European convention on human rights. The Liberal Democrat clause would be subject to even more abuse.
Beyond the vagueness, new clause 29 risks piling unbearable pressure on an economy already creaking under migration’s weight. Each new family member, however loosely defined, brings costs—in housing, where shortages already top 1.2 million units, in healthcare, with NHS waits stretching past 7 million, and in schools, where 9 million pupils squeeze into overstretched classrooms. The costs of supporting asylum for individuals run into the tens of thousands of pounds. Multiply that by thousands of dependants under this elastic clause, and we are staring at billions more siphoned from taxpayers, who have already seen their council tax spike. The Liberal Democrats do not set a cap; they fling the door open ever wider, ignoring how finite our resources are. Britain’s compassion has no bounds, but its resources certainly do. Our generosity must have limits. New clause 29 pretends otherwise, and working families will foot the bill when the system groans under the strain.
The new clause does not just invite claims; it opens a legal floodgate that could drown our courts in precedent-setting chaos by letting the Secretary of State define “family” on a whim. Whether we are talking about emotional ties or financial need, new clause 29 hands judges a blank slate to scribble ever-wider interpretations, building on the already elastic right to family life under article 8.
We have seen what has happened. As has been mentioned, an Albanian stayed because his son disliked foreign chicken nuggets. A Pakistani offender lingered, citing harshness to his kids. Let us now imagine dozens or hundreds of cases stacking up, each further stretching dependency—cousins, in-laws, distant kins—all cementing new norms that bind future policy. The Lib Dems would not just be tweaking rules; they would be unleashing a judicial snowball that would roll over border control for years to come. “Family unity” sounds noble, but the sprawl under new clause 29 could stall integration in its tracks—a challenge we cannot ignore when one in six UK residents was born abroad. Bringing in broad swathes of dependants, potentially with limited English skills or ties, risks clustering communities inward, not outward.
If we look across the channel, we see that Germany tightened family reunification after 1.1 million arrivals, capping it at 1,000 monthly for refugees’ kin, citing overload. We are not outliers for wanting clarity. Other nations prove it works, yet the Lib Dems chase a boundless model, ignoring how allies balance compassion with capacity, leaving us to pick up the pieces when this experiment fails.
The Parliamentary Under-Secretary of State for the Home Department (Seema Malhotra)
The hon. Member for Mid Dunbartonshire proposes an amendment that seeks to significantly change the current refugee family reunion policy, and to expand the current eligibility to include siblings, children under the age of 25 and any undefined family member.
The Government fully support the principle of family unity and the need to have provisions under the immigration rules that enable immediate family members to be reunited in the UK when their family life has been disrupted because of conflict or persecution. Accordingly, in recognition of the fact that families can become separated because of the nature of conflict or persecution, and because of the speed or manner in which people may be forced to flee their homes, communities and country, our refugee family reunion policy is extremely important and generous. The route enables those granted a form of protection in the UK to sponsor their partner or child to come to the UK, provided that they formed part of that family unit before they sought protection. Increasing numbers of visas have been granted through this route under the current policy, and indeed under the previous Administration. In 2024, 19,710 people were granted family reunion visas—twice the number in 2023, when around 9,300 visas were granted.
On the specific proposals in the new clause, it should be noted that any expansion of the existing approach without careful thought, including where such an expansion would allow an undefined family member to be brought to the UK, could significantly increase the number of people who qualify to come here, and runs the risk of abuse of those routes. That would have an impact on the taxpayer and could result in further pressures on public services and local authorities, which may have to accommodate and support the new arrivals.
We believe that introducing a rule that allows children to sponsor their relatives would risk creating incentives for more children to be encouraged or even forced, as we know can happen, to leave their families and risk hazardous journeys to the UK across the channel in small boats. That is a serious and legitimate concern regarding the best interests of those children.
Susan Murray
I thank the Minister. It is good to hear that the Government support the principle of family reunion, but we will press the new clause to a vote.
Question put, That the clause be read a Second time.
Matt Vickers
I beg to move, That the clause be read a Second time.
We believe that the right to remain in this country is a privilege, not a right. We also believe that to be able to stay in this country, a person must contribute to this country. As recent research by the Centre for Policy Studies has outlined, there is a risk that many of those coming to this country are either low-paid workers or have dependants who may or may not be working. Those individuals are likely to represent a long-term burden on the country’s finances rather than be net contributors. That sentiment has been reiterated by liberal publications such as The Economist, which only last week said in one of its leaders that
“governments must also learn from the policy mistakes that lend it credibility.”
Tom Hayes
It was remiss of me not to say earlier that I admire the hon. Gentleman’s tie—it is very nice. On the point he raises, I have said consistently that that particular report by the Centre for Policy Studies is flawed. As we move towards the Government’s new net migration White Paper, which will specify how we can bring labour into the country that is skilled only, rather than the low-wage labour that we saw under the previous Administration, there will not be that kind of burden in the future.
Matt Vickers
I aim to please with my tie. The hon. Gentleman can probably attach as much importance to the policy paper as he sees fit, as he does with anything else I might or might not say; it is for him, and for readers of the debate, to determine the value and weight they add to that. Another proposal we have put forward is on salary thresholds and what someone should be earning in order to remain in this country. I think that is a big deal; I will go on to outline why I think it is important, but yes—it is a big deal.
As I was saying, The Economist said only last week in one of its leaders that
“governments must also learn from the policy mistakes that lend it credibility. It was foolish to admit lots of newcomers without liberalising housing markets. Also, since migration flows to rich countries cannot be unlimited, it makes sense to favour highly skilled economic migrants over lower-skilled ones nearly all the time. Arguments for low-skilled migration built around supposed labour shortages are flawed.”
Interestingly, in countries outside the UK, research has shown the importance of income in long-term migration. A report in the Netherlands, which used detailed microdata on fiscal contributions and benefits to the entire population to calculate the discounted lifetime net contribution of the immigrant population present in 2016, was published in December 2024 and concluded:
“If the parents make a strongly negative net contribution, the second generation usually lags behind considerably as well. Therefore, the adage ‘it will all work out with the second generation’ does not hold true. High fiscal costs of immigrants are not that much caused by high absorption of government expenditures but rather by low contributions to taxes and social security premiums. We also find evidence for a strong relationship of average net contributions by country with cultural distance, even after controlling for average education and the cito-distribution-effect.”
Although we should acknowledge that the Netherlands is a different country with its own unique systems and that its situation does not necessarily apply to the UK, the finding highlights the need to examine the impact of migration decisions in comparable nations. New clause 32 takes steps to do that, ensuring that migrants contribute to our economy.
Mr Will Forster (Woking) (LD)
This is a very different hon. Member for Stockton West speaking now from the one who spoke last week, when he spoke against and voted against the Liberal Democrat amendment to allow and encourage asylum seekers to work so that they could benefit our economy. Does he not remember last week? Where was his concern for the taxpayer then?
Matt Vickers
I would suggest that that is quite a creative interpretation of last week’s events. This debate is about what people contribute when they are legally able to, rather than creating anything that would draw more people to make that crossing and to turn up in this country.
New clause 32 would revoke indefinite leave to remain in certain circumstances: that a person
“is defined as a ‘foreign criminal’ under section 32 of the UK Borders Act 2007”;
that the person
“was granted indefinite leave to remain after the coming into force of this Act,”
but has not spent 10 years resident in the UK;
that the person or their dependants
“have been in receipt of any form of ‘social protection’…from HM Government or a local authority”;
or that the person’s
“annual income has fallen below £38,700 for six months or more in aggregate during the relevant qualification period, or subsequent to receiving indefinite leave to remain.”
Let us be absolutely clear about one thing, because it is a cornerstone of this proposal and speaks volumes about who we are as a nation and what we stand for when the chips are down: anyone who has entered this country under the carefully crafted, well-designed and wholly principled safe and legal routes—those lifelines that we have extended through the Ukraine scheme, the British nationals overseas scheme or the Afghan schemes—would find themselves entirely exempt from the rigours of new clause 32, and rightly so. Those schemes are not just policies, but promises; they are solemn commitments that speak to our national character, and we stand by those we have pledged to protect.
Let us think of the more than 200,000 Ukrainians welcomed since 2022, fleeing Putin’s bombs—families clutching what they had, offered sanctuary through the Ukraine family scheme and Homes for Ukraine.
Chris Murray
Looking at the proposals set out in this new clause, how exactly is the hon. Gentleman proposing to calculate the £38,700? Is software available in the Home Office or in His Majesty’s Revenue and Customs? What if someone was found to have overpaid taxes after they were found not to meet the amount? Would the Home Office go and find them overseas and bring them back? This proposal sounds absurdly unworkable.
Matt Vickers
Lots of processes are in place, but we are putting down a principle. It is the same as the skilled worker visa threshold of £38,700. We have to set a line that requires people to be self-sufficient and not a drain on resources. This is the line that we are setting.
There are also Hongkongers. By 2025, nearly 180,000 British national overseas visa holders had escaped Beijing’s iron grip—huge British talent. More than 20,000 Afghans have been resettled since the Kabul airlift. Those were the right things to do, and we would exempt them from this proposal. These are not random arrivals; they are people we invited, whose stories of sacrifice and loyalty resonate with the values that we hold dear, from duty to decency. We would not renege on those commitments and tarnish the trust that we have built.
Let us cast our eyes across the globe, because other nations are not just theorising about this; they are proving that it works, day in, day out, with systems that do not just talk a good game but deliver tangible, measurable results that we would be foolish to overlook. Take Australia, a land of vast horizons and sharper borders, whose points-based residency system does not mess around. If someone is pulling in less than 53,900 Australian dollars—£28,000—and they are dipping into welfare, Australia will show them the door, an approach that is saving taxpayers billions.
These are not quirky outliers or flukes; they are lessons carved in policy stone and shining examples that tying status to contribution is not some pie-in-the-sky dream but a practical, proven playbook that delivers real savings and sharper borders, and stands up to scrutiny. New clause 32 lifts straight from that script, making £38,700 the line in the sand, with no benefits to lean on and no criminal record to tarnish the deal. It is not radical; it is road-tested, and echoes what works elsewhere on the globe.
Critics might cry, “Unworkable!” but the conditions in new clause 32 are trackable. HMRC already logs income for tax. The Home Office flags criminals under the UK Borders Act 2007, and the Department for Work and Pensions tracks benefits down to the penny. We are not reinventing the wheel—just syncing data to enforce the rules, with £38,700 as a clear line, 10 years as a fair test, and exemptions for the Ukraine, Afghan and British national overseas schemes, showing that we can tailor it.
This is a framework that says, “If you’re here for the long haul, you’ve got to bring something to the table, not just pull up a seat.” Australia and Canada have shown us the path with lower costs and tighter controls; we would be stupid not to take it. I would like to know why the Government would disagree with the principles behind the new clause. Why do the Government want foreign criminals to remain in the UK with indefinite leave to remain? If the Government believe in the £38,700 amount for skilled workers to obtain a visa, why would that not apply to people remaining in the UK indefinitely?
Pete Wishart (Perth and Kinross-shire) (SNP)
I was not going to speak to the new clause; I was just going to let the hon. Gentleman drone on, in the hope that we could possibly get away on Thursday morning, but I have been irked to my feet. I am not sure whether I prefer the new loquacious hon. Member for Stockton West. I do not know what he has done about his speechwriting, but I preferred the version that we had last week. That was probably more in keeping with the Conservatives’ contributions to this Committee.
This is a horrible new clause, which penalises lower-income workers, deters skilled immigration and harms vulnerable groups. The retrospective nature of some of the provisions is simply absurd, and would lead only to legal challenges and all sorts of administrative complications. The new clause would introduce retrospective punishments, taking ILR away from individuals who had received it under the previous rules simply because a future Government—thank goodness this will never be so—had later decided to raise the bar. People make long-term decisions to buy homes, raise families and contribute to communities based on the stability of ILR. Changing the rules after the fact destroys trust in the whole system.
The proposal sets an arbitrary income threshold of £38,700, meaning that a nurse, teacher or social worker—people the UK depends on—could lose their ILR. Many industries, including healthcare, hospitality and retail have workers earning below that level. Are we really saying that under no circumstances would they be welcome? The proposal also ignores economic realities. People face job losses, illness or temporary hardships. Should losing a job also mean losing the right to live in the UK?
New clause 32 states that ILR should be revoked if a person has received any sort of “social protection”, including housing support. This would punish people who have worked hard and contributed but who need temporary support due to circumstances often beyond their control. It targets families, disabled people and those facing financial hardship, effectively saying, “If you need help, you don’t belong here.” Skilled workers, investors and entrepreneurs want certainty. If they fear that a downturn in income or a short period of hardship could see them lose their right to remain, they will choose other countries over the UK.
As we have also heard, how can this be enforced? Constantly monitoring ILR-holders’ income, benefits and job status would be an administrative disaster; it would be costly, error prone and unfairly target individuals. This new clause is simply cruel. It is unnecessary and unworkable, and I hope that it is rejected out of hand.
Katie Lam (Weald of Kent) (Con)
We have spoken already about indefinite leave to remain, which is also referred to as settlement. We have discussed the most basic requirement for eligibility, which is time, and our suggestion that the timeframe be extended from five years to 10. The new clause covers revocation, or the circumstances in which we believe that indefinite leave to remain status should be removed from an individual to whom it has been granted.
As my hon. Friend the Member for Stockton West set out, the first of these conditions is whether a person has engaged in criminality. Our definition for criminality is based on that used in section 32 of the UK Borders Act 2007, under which a person is a “foreign criminal” if they are neither a British nor an Irish citizen; if they have been convicted of an offence, where that conviction takes place in the United Kingdom; and if the period of imprisonment to which they are sentenced is at least 12 months. It also applies to a person who is a “serious criminal”, as defined in section 72(4)(a) of the Nationality, Immigration and Asylum Act 2002.
It is already the case that individuals with settled status can be deported from the UK by having ILR status revoked at the discretion of the Home Secretary. This new clause makes that process automatic. We can see no reason why a person who has committed a crime—particularly based on the current legislation—that is so serious that they are sentenced to a year in prison should be able to continue to be in this country at all, let alone to retain ILR status and with it all the generosity and safety net of the British welfare state, including social housing, benefits and free healthcare.
Secondly, we have included in this new clause a condition that is effectively a knock-on effect from our earlier new clause 25, which would revoke ILR status conferred after this Act comes into force, where that status would not have been conferred under these new conditions.
Thirdly, the new clause applies to those who have been in receipt of social protection, as defined by the Treasury’s “Public Expenditure Statistical Analyses”, which includes personal social services in various different categories, as well as incapacity, disability and injury benefits, pensions, family benefits, income support and tax credits, unemployment benefits, universal credit and social housing. Social protection is a fundamental part of modern British society, but we should be honest that it is also incredibly expensive. Such generous provision should be available only to citizens. It must be a fundamental principle of our system that those who come to this country contribute fiscally more than they cost. What they pay in tax should more than cover the cost of the public services that they use. That is the opposite of the situation that we have now; only a small proportion of those who have come to this country over the past few years are likely to be net lifetime contributors. That is unaffordable.
That reality also underpins our final condition of income falling below £38,700 for six months or more in aggregate. That figure of £38,700 was chosen to sit alongside the general skilled worker threshold, the minimum earnings threshold for skilled worker visas, and the minimum income requirement for a family visa sponsor proposed by the last Government. It was chosen as it represents the 50th percentile, or the median, of earnings for jobs at the skill level of RQF3—level 3 of the regulated qualifications framework—which is perhaps more easily recognisable as the equivalent of A-levels and BTECs.
We believe that the new clause will go some way to addressing the problems that we have set out of very high volumes of people coming to this country in recent years who are not set to be net fiscal contributors to the public purse over the course of their lifetimes. We hope that the Government will consider adding it to the Bill.
We also welcome the comments from the Minister on the fact that she is looking at this issue. Could she tell us specifically whether she is looking at any of these conditions, and, if so, which? How are her discussions coming along, and when does she hope to report back to the House on her plans?
Seema Malhotra
I am pleased to speak about new clause 32, which would mean that people who are settled in the UK had that status automatically revoked in a wide range of circumstances. Irrespective of any other relevant factors, such as how long a person has lived here, settlement could be automatically revoked when a person earns less than £38,700, has received benefits or would not meet requirements for settlement that have subsequently changed.
We have heard important contributions from hon. Members across the Committee about why that is unworkable, for a range of reasons. I understand why the Government are seeking to bring this forward—[Interruption.] Sorry, the Opposition—it was a slip of the tongue. I also understand that the shadow Minister is seeking to continue his run of speeches—with his new tie today—in this Committee sitting, but let me lay out a couple of circumstances that clearly show that the new clause would be unworkable.
The proposals would create injustice in certain cases. People who are settled and have been paying tax and national insurance contributions for decades could have their settlement revoked because they temporarily fall on hard times. Let us imagine, for example, a couple—a British man with his American partner—who have been living together in this country for many years. He gets badly sick and he cannot work. She ends up having to look after him in local authority housing. I guess that under the Opposition’s rules, when he dies, she would be banned from settling in the UK. That is the sort of circumstance that would logically follow.
It is important to note as well that most migrants become eligible to access public funds only at the point at which they gain settlement—mainly ILR. The expectation is that temporary migrants coming to the UK should be able to maintain and to accommodate themselves without recourse to public funds. That approach reflects the need to maintain the general public’s confidence that immigration brings benefits to our country, rather than costs to the public purse. I can understand that as an underlying driver for some of today’s debate, but it is important that we keep this in the context of an immigration system that is fair, controlled and managed. The no recourse to public funds policy is a long-standing principle adopted by successive Governments. There is also an ability to apply for the no recourse to public funds condition to be lifted in certain circumstances, so there are safeguards for the most vulnerable.
Let me turn to the new clause’s other core condition, on revoking the ILR of a “foreign criminal”—the shadow Minister referred specifically to that. As we have said before, and throughout this Committee, settlement in the UK is a privilege, not an automatic entitlement. Settlement conveys significant benefits and provides a pathway to British citizenship. Settlement can be revoked for criminality, deception or fraud in obtaining settlement, or other significant non-conducive reasons. A person’s settlement is also invalidated if they are deported. The Government have been clear—in fact, we could not have been clearer—that foreign criminals should be deported from the UK whenever it is legal to do so. Any foreign national who is convicted of a crime and given a prison sentence is considered for deportation at the earliest opportunity.
I want to emphasise another point—Government Members, in particular, have mentioned this—about the figures from the Centre for Policy Studies. It is worth repeating that figures in that report refer to a period of historically high levels of net migration under the previous Government. For that and many other reasons, they are not a sound basis for an evidence-based discussion.
Seema Malhotra
I will—I expect the hon. Lady to make the point she made earlier.
Seema Malhotra
I just mention that we have the upcoming immigration White Paper, in which we will set out our approach to the immigration system and how to support it to be better controlled and managed for the future. We are clear that net migration must come down. She will know that under the previous Government—to which she was a special adviser—between 2019 and 2024, net migration almost quadrupled. That was heavily driven by a big increase in overseas recruitment. A properly controlled and managed immigration system, alongside strong border security, is one of the foundations of the Government’s plan for change. It is extremely important to have a debate based on tackling those root causes and issues, rather than tinkering around the edges and having a scenario in which the partner of a British citizen, who subsequently falls ill and dies, has her ILR revoked. It is important to understand what the Opposition tabling such amendments means for people’s lives and fairness in our society.
Tom Hayes
Briefly, prompted by the Opposition, we are inching towards a more interesting debate, on how to assess the financial benefits and costs of migration, while grounding that in available and high-quality data. In 2021, in Australia, the Treasury undertook a fiscal assessment and has repeated that annually. I know, too, that the Migration Advisory Committee is looking to improve the quality of data, because over 14 years we have had such poor-quality data on which to make assessments. It is starting to look at different categories of workers in order to assess whether they are net contributors or net drags. That is a really positive step.
One of the reasons why we are relying on “best” or “only” reports is because we had a Government who could have improved the quality of the data to make managed assessments of what controlled immigration that benefits our economy would look like, but instead, unfortunately, we had the borders thrown open with no sense of what our economy ought to be or what the skills ought to be, which is regrettable. Will the Minister comment on the importance of the White Paper to drive forward the immigration system that we actually need, grounded in the data that we need?
Seema Malhotra
My hon. Friend highlights a crucial point about the importance of evidence-based policy and of good data, which was sorely lacking across the whole immigration system when we came into office. The utter chaos, with backlogs in every part of the system, put huge pressure on it and made it much harder to get information about where the backlogs were and who was in them in order to try to exert some control over the system and get that important data to inform future policy.
My hon. Friend is right to point to the Migration Advisory Committee, which continues to do important work to engage with stakeholders and to work across Government. That is an important part of the work that we are doing to use evidence in a much better way to inform how we link skills policy and visa policy. The work to restore order to our immigration system has been under way since we came into office. We will set out our approach, as he has intimated, in our upcoming immigration White Paper. I am grateful to have had the opportunity to explain why we will not support the amendment, and I respectfully suggest that the hon. Member for Stockton West may wish to withdraw it.
Katie Lam
I welcome the Minister’s response, particularly her words about the importance of settlement and citizenship being earned. The Opposition are excited to see the immigration White Paper, and particularly any data and fiscal impact analyses that it may contain. I apologise if this information is already publicly available and I am not aware of it, but can the Minister tell us when the White Paper is due to be published? Can she also set out a scenario in which it would be preferable for a foreign criminal to remain in this country after having been convicted of a crime, and why she considers the new clause to be unworkable?
Seema Malhotra
We have said that we hope to publish the immigration White Paper later in the spring. I have made some remarks in relation to foreign criminals; the Government are clear that they should be deported from the UK whenever it is legal to do so. Any foreign national who is convicted of a crime and given a prison sentence is considered for deportation at the earliest opportunity.
Seema Malhotra
I thank the hon. Member for that point. I have laid out the argument about needing an immigration system that is subject to rules and that can recognise different circumstances. I have also laid out the point about foreign criminals and where it is legal to deport them. Anyone who is convicted of a crime is considered for that.
The hon. Member will also understand that there can be complexity in people’s arrangements. Anything that becomes automatic in the way that she describes needs to be subject to much more debate than a new clause in this Bill Committee. We are not debating immigration; we are debating a system to stop the gangs and improve our border security. It is important that we see the purpose for which this legislation has been designed.
Matt Vickers
We feel strongly about the measures in the new clause, and we wish to press it to a Division.
Question put, That the clause be read a Second time.
Matt Vickers
I beg to move, That the clause be read a Second time.
New clause 33 aims to help the Government by providing a way to put securing our borders above spurious human rights claims to frustrate removal. It would disapply the entire Human Rights Act 1998, as well as any interim measures of the Strasbourg court that prevent the effective operation of legislation relating to immigration and deportation. The result would be that those seeking to appeal deportation or other immigration decisions would not be able to make human rights claims under the Human Rights Act in British courts.
The new clause would apply that new power to all aspects of immigration control, including enforcement, deportation, the granting or removal of immigration and asylum status, and any other immigration entitlements. We would expect Parliament to legislate and the Home Office to decide immigration cases based on their reasonable interpretation of the European convention on human rights, but UK judges would be able to use only UK law passed by Parliament to decide appeals, and no longer make expansive and common-sense-defying interpretations of what they claim the ECHR means.
The Human Rights Act would still apply to non-immigration matters, so UK judges could continue to apply the ECHR directly to them. We would still be under the ECHR, so applicants would still be able to go to the Strasbourg court, but the new clause would stop UK judges expanding the definitions. In that scenario, it would be possible to deport people pending a Strasbourg appeal, and it would repeat the measure in the Safety of Rwanda (Asylum and Immigration) Act 2024 to give Ministers the power to ignore an ECHR rule 39 interim order. We are not saying that the new clause provides the full answer to controlling our borders. Wider questions such as ECHR membership and wider immigration system reforms are to be addressed in longer-term pieces of work, but the new clause would be a step in the right direction.
The reason the new clause is necessary can be seen in recent decisions about immigration appeals. For example, an Iraqi drug dealer was saved from deportation from the UK after a judge ruled that he was too westernised to be returned to his home country. That man, who was jailed for more than five years after a conviction for dealing cocaine, had lived in Britain for 24 years and has a British-born daughter. Home Office officials attempted to have him deported, but a specialist judge in the asylum tribunal ruled that returning the man to Iraq would violate his human rights as he would be viewed with suspicion. The judge said that the man, who cannot be named, would face persecution in Iraq because he would be seen as westernised.
As we have already mentioned, an Albanian criminal was allowed to stay in Britain partly because his son would not eat foreign chicken nuggets. An immigration tribunal ruled that it would be unduly harsh for the 10-year-old boy to be forced to move to Albania with his father, owing to his sensitivity around food. The sole example provided to the court was his distaste for the type of chicken nuggets available abroad.
Chris Murray
I wonder whether the hon. Gentleman could just assume that we are familiar with those two cases by now and either not bother citing them or think of some new examples to support his arguments.
Matt Vickers
I think they are relevant; they are things that both the public and I are bothered about. They show the failings of the system and why people are so concerned about the way that it is going.
As a result, the judge allowed the father’s appeal against deportation as a breach of his right to family life under the European convention on human rights, citing the impact that his removal might have on his son. An attempt to deport a Sri Lankan paedophile, who was convicted of assaulting three teenage boys, was delayed over claims that deportation would breach his human rights.
Matt Vickers
I am concerned about the consequences of the Human Rights Act for cases such as this and its role therein.
Matt Vickers
I am concerned, in the context of this new clause, about what the Human Rights Act means for these immigration cases. That is why the new clause proposes to remove its impact and disapply it.
Tom Hayes
I am still not very clear—I apologise, maybe I ate too much at lunch. Does the hon. Gentleman have issues with the Human Rights Act such that he believes that we ought not to be applying it generally? Is this the first step towards its disapplication, or is he more concerned that, while the legislation is fine, we have in what seems a minority of cases judges who are not applying it correctly? Could he also tell me whether what he has here is a snapshot of cases that he is concerned about or the totality of cases that he is concerned about?
Matt Vickers
We have talked about the relevance of disapplying the Human Rights Act with regards to immigration and the impact that it is having on these cases. I think I have been clear, and the hon. Gentleman can read Hansard.
As I was saying, the man was jailed for five offences of sexual activity with a child but has been able to stay in Britain since 2011, owing to a protracted dispute over his asylum case. In 2012, the man, who cannot be named, was branded in court a “danger to the community” over his offences against boys aged between 13 and 15. He then applied for asylum by claiming that his life would be at risk were he to return to Sri Lanka, because he is gay. Since his initial application, his case has been through several court hearings, as judges have assessed whether deporting the 50-year-old would breach his human rights. Those are just three examples of how ever-expanding interpretations of the Human Rights Act have been increasingly frustrating the removal of those who objectively ought to be deported.
Matt Vickers
I think if we allowed first-tier tribunals to go public, we would see a lot more. These things undermine public confidence in the legal framework and the institutions that uphold them, and I think they are terribly wrong. One of these cases is one too many. They are happening in ever-increasing numbers; that is why we have tabled this new clause, and the hon. Gentleman will have the opportunity to vote for it or otherwise.
Our new clause represents a first step to restore some common sense to immigration appeals. New clause 33 steps up to wrest back control from a judiciary that has wandered far from the reservation, turning the Human Rights Act into a sprawling, open-ended blank cheque for immigration status, a carte blanche that has left us all scratching our heads at the sheer audacity of it.
Tom Hayes
That is also a helpful clarification, because the hon. Gentleman’s concern is with the judiciary and its behaviours. Can I clarify what he has just said, exactly as I heard it: his concern is purely about the judge’s application of the Human Rights Act, and he himself is absolutely fine with the Act?
Matt Vickers
We allow our domestic courts to use it. We have created the framework and put it in place, and they do what they can with what is in front of them. I am concerned about the way in which it is applied, and we need to change that if we want to impact the outcomes of those cases and appeals.
Last year alone, we saw far too many appeals built on article 8, the right to a family life, flooding courts with ridiculously broad pleas. This Parliament is elected to decide the laws of the land. Judges are there to uphold that law, yet they have morphed into border gatekeepers, perched on high and second-guessing Home Office decisions with interpretations so elastic they would snap any thread of reason, and family life ballooning to mean whatever they fancy on any given day. The new clause yanks that power back to where it belongs: with MPs, who are answerable to the people who elect them.
New clause 33 is not just a legal tweak; it is a turbocharge for a deportation system bogged down by endless appeals, with removals stalled by Human Rights Act challenges. Each case drags on, costing tens of thousands of pounds per detainee in legal fees and housing, and clogging up detention centres that are already at capacity. Disapplying the Human Rights Act for immigration would fix the logjam, letting Ministers and officials act fast, deporting those our domestic legislation was created to deport and freeing up resources for border patrols and visa processing, which actually keep us secure.
New clause 33 would restore public safety—a lifeline for a priority that has been fraying at the edges and unravelling thread by thread, as dangerous individuals exploit Human Rights Act loopholes to cling to our soil like barnacles on a ship. In 2024 alone, thousands of foreign national offenders—thieves, drug peddlers and worse—languished in UK prisons, costing taxpayers millions to house. Nowhere near enough were bundled on to planes and removed, leaving thousands to stroll out post their sentence, free to roam our streets, because of Human Rights Act claims tying our hands and deviating from Parliament’s intended outcomes.
New clause 33 would cut through that mess. It would mean swift, no-nonsense removal of those who have shattered our laws—not endless hand-wringing debates over some nebulous right to stay that keeps them loitering in our towns. Public opinion, or the view of British law-abiding taxpayers, is clear—nearly three quarters call for foreign criminals to be removed—yet here we are. The current set-up lets threats fester when they should be gone. As the months go by, more of these bizarre judgments emerge, undermining public confidence in the entire system and our legal institutions.
Let us take a tour beyond our shores, because other nations are not fumbling in the dark; they are lighting the way, showing us that this is not some wild, radical leap but a steady, proven path that we would be daft not to tread. For starters, France increased its deportations by 27%, and is also seen to be deftly side-stepping ECHR interim measures, with domestic law overrides. Twenty-seven per cent. sent home—no faffing about with Strasbourg rule 39 edicts; just a clear-eyed focus on keeping France’s borders taut and its streets secure.
Then there is Australia, where the Migration Act does not blink. Rights claims bow to border control, and many are whisked out yearly with minimal fuss. The law, created by those elected to do so, determines who stays and who goes. These are not rogue states; they are democracies—proud and pragmatic, balancing security with sovereignty. New clause 33 strides right into that company. Parliament would lay down the law, not Strasbourg’s fleeting winds, echoing what has clicked abroad, from Paris to Perth.
I would be interested in the Minister’s thoughts on this proposal—in particular, whether she thinks that some of the recent examples of failed deportations are acceptable. We are apparently very familiar with chicken nugget-gate. If she agrees that some of these outcomes are unacceptable but does not feel that this approach is the way forwards, how will the Government end these cases, which are making a mockery of our justice system and undermining public confidence in our legal institutions?
Pete Wishart
I am compelled again to rise in opposition to what is probably the most egregious of all the new clauses that we are having to consider in today’s marshalled groups. The hon. Gentleman has laid some competition before us, but this new clause is by far the most disgraceful and appalling. The Human Rights Act is an important guarantee. It is what makes us good world citizens and provides rights that are universal. It protects fundamental freedoms such as the right to life, the prohibition on torture and the right to a fair trial—and the Tories do not like it one bit. The right-wing nonsense that we heard from the hon. Gentleman is a fundamental departure from the principle that human rights apply universally, not just to those the Government deem worthy. It is a dangerous precedent that undermines the UK’s long-standing commitment to justice, fairness and the rule of law.
Katie Lam
In November 2024, a Congolese paedophile who sexually assaulted his own stepdaughter was allowed to remain in the UK despite the Government’s attempts to deport him, out of concern that forcing him to leave the country would interfere with his right to a family life. In December 2024, a Turkish heroin peddler was allowed to stay in the UK because it was ruled that deporting him would interfere unduly with his family life, despite the fact that he had returned to Turkey eight times since coming to Britain.
In February of this year, a Nigerian woman who was refused asylum eight times was allowed to remain in the UK because it was decided that her membership of a terrorist organisation might make her subject to persecution in her home country. Earlier this month, a Nigerian drug dealer escaped deportation because he believed that he was suffering from “demonic forces”. Meanwhile, Samuel Frimpong, a Ghanaian fraudster, has been allowed to return to the UK, having being deported 12 years ago, after claiming that he is depressed in his home country.
The list goes on and on. Absurd asylum rulings from our tribunal system seem to emerge on an almost daily basis. What do these cases have in common? In each one, a potentially dangerous person was spared deportation because of our membership of the European convention on human rights, and, crucially, the domestic legislation that enshrines the convention in British law—the Human Rights Act. This legislation is clearly not fit for purpose when it comes to managing and securing the border. It is enabling dangerous foreign criminals to remain in the UK, and putting the British public at risk.
It is time we recognised that decisions about asylum and immigration should be made by politically accountable Ministers, rather than by unaccountable judges and tribunals. That is the purpose of our new clause, which seeks to disapply the Human Rights Act and interim measures of the European Court of Human Rights in relation to the Bill and other legislation about borders, asylum and immigration.
Pete Wishart
Just to clarify, I think the hon. Lady is saying clearly that what she intends to do is to take decisions about immigration out of the hands of judges, and leave them in the hands of politicians. Is that her intention?
Katie Lam
I will make a little progress.
The concept of universal rights is clearly a good one. It is one of the great gifts to humanity of the Judeo-Christian tradition to recognise that every human life has inherent worth, and every human being should be treated with the dignity that that inherent worth confers. But any set of rules that people might write over time can be distorted or abused, or exploited to take advantage of our society, our kindness and the British impulse and instinct towards trust, tolerance and generosity. Our rules and laws on human rights, and the organisations to which we belong that were created in the name of human rights, should be subject to scrutiny and debate no less than any other rules and laws. Lord Jonathan Sumption, the former Supreme Court judge, said that the United Kingdom’s adherence to the European convention on human rights
“raises a major constitutional issue which ought to concern people all across the political spectrum.”
It is right for us to interrogate our rules. Indeed, that is arguably our main job and the fundamental reason we have been sent here by our constituents. None of our laws should be above repeal, replacement or disapplication, and that must include the Human Rights Act. We are among the luckiest people in the world in that we live in a democracy, and one that I believe has the world’s greatest people as its voters. When the British people see repeated activity that contravenes our national common sense, politicians in Westminster must acknowledge that and do something about it.
If the Government do not wish to disapply the Human Rights Act and interim measures of the European Court of Human Rights in matters of asylum and immigration in order to control the border and put a stop to the perverse cases and decisions we are seeing relentlessly arise in the courts, what is their solution? How will they restore common sense, fairness and the primacy of public safety to the security of the border?
The Chair
Before I call the Minister, I will just point out that Erskine May urges us not to be critical of judges in UK superior courts. I am sure hon. and right hon. Members will wish to be circumspect in their remarks.
Dame Angela Eagle
I am not sure how much of the debate we could have heard, Dr Murrison, had you made that observation at the beginning of it.
I do not think this Government wish to join Belarus and Russia among those who are not signed up to the European Court of Human Rights. The Government are fully committed to the protection of human rights. When we talk about human rights, that means all people who are human: everybody, applied universally.
As the Prime Minister has made clear, the United Kingdom is unequivocally committed to the European convention on human rights. The Human Rights Act is an important part of our constitutional arrangements and fundamental to human rights protections in the UK. To start taking those away on a bit-by-bit basis, particularly beginning with people who are very unpopular and have done difficult or bad things, could be the start of a very slippery slope if we are not careful. That is why I am proud that our Border Security, Asylum and Immigration Bill has printed on its front cover that it is compatible with convention rights. This Government will always do things that are compatible with convention rights.
The paradox of some of what has been said in the debate we have just had is that it politicises decisions. That is a very different approach to judicial issues from the one we have seen for very many years, where, in effect, a lot of the powers on particular issues that used to sit with the Home Secretary have been taken by judges who are publicly accountable for their decisions. I do not think that this Government would want to see that reversed. The paradox of new clause 33 is that all those who potentially had a human rights claim, whatever their circumstances, could go straight to the Strasbourg court, which would clog up that court. As the hon. Member for Perth and Kinross-shire pointed out, that is not taking back control, it is abrogating it, and would flood the Strasbourg court with decisions that could have sensibly been taken here.
That is not to say that any one of us would not be frustrated by particular individual decisions, but I caution against using decisions that have been only partially covered or talked about on the front pages of The Daily Telegraph, which often takes decisions in cases out of context. We have talked a lot about chicken nuggets, and I would just put on the record that that case is being appealed, and judicial activities on that case have not yet finished.
With that commitment to human rights and European convention rights, I hope that Opposition Members will think about some of the potential consequences of what they are suggesting in chopping up human rights and wanting to put us in the same company as Belarus and Russia; about the way convention rights were developed; and about the benefits that adhering to human rights frameworks has given us as a democracy over the years.
Matt Vickers
I am sure that the Minister must disagree with some of the examples that we have seen, and agree that they undermine public trust in the judiciary, legal institutions and the frameworks we have. What is the solution? Must we grin and bear the appalling outcomes of those cases or is there a solution? How does she propose to stop such things happening?
Dame Angela Eagle
I would respectfully say that the hon. Gentleman’s party had many, many years to think of a solution, and most of the cases that Opposition Members have raised today had their genesis in the years that they were in power. Close to the very end, as they became more and more frustrated, they started coming up with more and more outlandish approaches.
Obviously, one wants the entire judicial process to be used, as speedily as possible, and if the Home Office wishes to appeal a particular case, it will do so. We keep a constant eye on the issues and we think about reforms that we could make. Obviously the hon. Gentleman will be the first to hear if we decide to make changes, but we do not wish to abrogate from the Human Rights Act, the ECHR and the human rights framework. That is where we and other Opposition parties differ from him and his party. That is why I do not accept new clause 33 and I hope that the Committee will vote against it if it is pressed to a vote.
Katie Lam
I hope it was clear in my remarks, but for the avoidance of doubt or ambiguity I want to say that the Opposition do not criticise our judges. Indeed, as my hon. Friend the Member for Stockton West said, they are doing the best they can with the rules and precedents under which they operate. That is why the new clause seeks to change those rules—
Tom Hayes
With the greatest respect, a reading of the Hansard report of what the hon. Member for Stockton West said would be contrary to what the hon. Lady has just asserted. What the hon. Gentleman said could in no way, shape or form be described as complimentary to or supportive of judges. In fact, it was very undermining of judges.
Matt Vickers
The public are appalled by these cases. The hon. Member for Perth and Kinross-shire does not want us to change legal frameworks over chicken nuggets: if the Human Rights Act creates a situation in which criminals, rapists and paedophiles are able to stay against domestic law and the intentions of the people charged with making that law, it is unacceptable. We feel strongly about this and wish to divide on the matter.
The Chair
With this it will be convenient to consider new clause 42—Removals from the United Kingdom: visa penalties for uncooperative countries—
“(1) The Nationality and Borders Act 2022 is amended as follows.
(2) In section 70, omit subsections (4) and (5).
(3) In
(4) In section 72—
(a) subsection (1), after ‘A country’, for ‘may’ substitute ‘must’.
(b) In subsection (1)(a) omit ‘and’ and insert—
‘or,
(ab) is not cooperating in relation to the verification of identity or status of individuals who are likely to be nationals or citizens of the country, and’
(c) in subsection (1)(b), after ‘citizens of the country’ insert ‘or individuals who are likely to be nationals or citizens of the country’,
(d) omit subsections (2) and (3), and
(e) in subsection (4), omit from ‘70’ to after ‘subsection (1)(a)’ .
(5) Omit section 74.”—(Matt Vickers.)
This new clause would require the Secretary of State to use a visa penalty provision if a country is not cooperating in the removal of any of its nationals or citizens from the UK, or in relation to the verification of their identity or status.
Matt Vickers
Currently a prison sentence of one year is required before a foreign national who is a convicted criminal can be deported. Even then, removal can be frustrated by asylum and human rights claims. New clause 34 would prevent a foreign national who is convicted of any offence from remaining in the UK, as well as anyone who has been charged with or convicted of an immigration offence under section 24 of the Immigration Act 1971, and would disapply the Human Rights Act from those cases. We believe that the protection of British citizens is paramount and should be the overriding priority for Government. If a foreign national has been convicted of any offence, they should lose their right to remain in the UK.
Dame Angela Eagle
On that point we agree, so why was his Government so tardy at actually deporting foreign national offenders when they were in office?
Matt Vickers
We have just had a lengthy discussion about the Human Rights Act and the impact it has on deportations. However, if she agrees so wholeheartedly on the principle, I am sure she might consider backing our amendment.
There are a number of countries where the UK has a significant number of foreign national offenders currently serving in British prisons. However, we deport only a small number of those foreign national offenders each quarter. Our new clause 42 would require the Secretary of State to use a visa penalty provision if a country is not co-operating in the removal of any of its nationals or citizens from the UK, or in relation to the verification of their identity or status. We have done this by amending the Nationality and Borders Act, so that the ability to impose visa sanctions is not discretionary but mandatory. We know that there are countries that are hard to secure returns to. We believe strongly that that should not be without consequences for those countries.
New clause 34 shifts the lens to where it belongs—on the victims left in the wake of foreign offenders, not the perpetrators gaming the system. In 2024, theft offences alone averaged just 8.1 months—a shopkeeper’s livelihood dented, a pensioner’s purse snatched, or a family’s peace of mind and sense of security destroyed. Public order crimes averaged just 9.6 months, with more huge consequences for the wellbeing of victims who are left with a fear of entering public spaces or unable to go about their ordinary lives. Yet the one year deportation bar enables those culprits to linger, post-sentence, free to reoffend while victims wait for justice that never comes.
This clause says, “Enough.” Any conviction, for shoplifting or worse, triggers removal—no Human Rights Act excuses—because every day a foreign offender is allowed to stay is another day a British victim’s trust in the system erodes. Why are the Government okay with that shadow hanging over our streets? New clause 42 would force nations to play ball uphill. We see too many countries dither and delay in refusing to take back offenders. Mandatory visa sanctions flip that script. No co-operation, no UK visas for their elite. Watch fast how passports materialise when there are real consequences. Why is Labour soft-pedalling when we could wield this stick, clear the backlog and reduce pressure on prison places?
Katie Lam
New clause 34 prevents any foreign national who is convicted of any offence from remaining in the UK. It should be a fundamental principle of our system that immigration never makes the British public any less safe. Unfortunately, however, many of those who have come to the UK in recent years have broken our laws. According to Ministry of Justice figures, a staggering 23% of sexual crimes in the UK—almost one in four—are committed by foreign nationals.
The overall imprisonment rate for foreign nationals is 20% higher than that for British citizens. Of course, the trend is not uniform: some nationalities are more heavily represented than others. Albanian migrants are nearly 17 times more likely to be imprisoned than average; those from Algeria are nearly nine times more likely and those from Jamaica nearly eight times more likely to be imprisoned than average.
Those who seek to harm this country, to break its laws and to undermine what we hold to be fair and right should not be allowed to remain here. As the Government are well aware, our prisons are already overcrowded. We must not allow foreign criminals to continue exacerbating this problem and we must not endanger the British public by allowing foreign criminals to stay in this country.
Under our current system, too many of those who break our laws are being allowed to remain in the UK. Often, Home Office attempts to deport foreign criminals are blocked because of absurd and ever expanding human rights rules. In the interests of public safety, we must not allow foreign criminals to remain in Britain; that includes by making sure that the Human Rights Act cannot be used to prevent us from deporting those who break our laws.
How, specifically, does new clause 34 do that? It amends section 32 of the UK Borders Act 2007, which we have already mentioned today. Section 32 would be amended from its current form, which defines a foreign criminal as a person who is neither a British nor an Irish citizen, who is convicted of an offence that takes place in the United Kingdom and who is sentenced to a period of imprisonment of least 12 months, or is a serious criminal as defined in section 72 of the Nationality, Immigration and Asylum Act 2002. What would replace section 32 would be much simpler; it would instead say that a foreign criminal was anyone who is neither a British nor an Irish citizen who is convicted of any offence in the United Kingdom, and explicitly include within that anybody who has been charged with or convicted of an offence under section 24 of the Immigration Act 1971, which sets out the situations in which a person can be considered to have entered this country illegally. That includes if they do so in breach of a deportation order; if they required leave to enter the United Kingdom and knowingly came here without that leave; or if they required leave to enter the United Kingdom and knowingly stayed here beyond the time conferred by that leave, among other specific conditions.
New clause 34 also seeks to ensure that the rules will be upheld in all circumstances and asserts therefore that the principle of removing criminals from this country is of utmost importance and must be prioritised above other legislation. That includes human rights legislation, for the reasons we have already set out.
I turn to new clause 42, which requires the Secretary of State to use a visa penalty provision if a country proves to be unco-operative in the process of removing any of its nationals or citizens from the UK. Such a lack of co-operation may arise in verifying their identity or status or it may pertain to the process of removing people whose identity and status has not been established. New clause 42 seeks to do that by amending section 70 of the Nationality and Borders Act 2022. That Act set out the idea of a visa penalty provision, effectively allowing the Home Secretary to suspend visa applications from countries that do not co-operate with the activity that the Government are trying to take to secure and protect the border. The new clause would strengthen that Act by changing that from an option for the Home Secretary to a duty and by adding explicitly the point about countries that are not co-operating with the process of verifying the identity or status of individuals whom we consider likely to be nationals or citizens of the countries in question.
Pete Wishart
I am struggling to understand this new clause. There are a number of reasons why other countries may not be able co-operate with the UK on immigration and visa cases—it could be political instability, or there could be a right-wing despot in charge—but that impacts on ordinary asylum seekers. Does the hon. Lady not accept that there are a number of political or even administrative reasons why they are not always able to co-operate?
Tom Hayes
A volume of information seems to be coming at us now, and it feels as though every 20 words, something absolutely absurd is said. It is a marked contrast with what has gone before. I see the hon. Member for Weald of Kent and the hon. Member for Stockton West standing there, but I hear the voices of other people in their party. It feels very peculiar.
I have a specific question. Quite apart from the fact that the Conservatives effectively decriminalised shoplifting, if an Albanian national is convicted of shoplifting but cannot be deported to Albania, is the hon. Lady saying that she would impose a visa penalty on Albania if it did not accept that shoplifting Albanian national, regardless of what that might do for the wider relationship between Albania and the UK in terms of deportations?
Katie Lam
In that case, I am happy to reassure him that I wrote every word.
The short answer to the question about Albania is yes. We think that would be completely appropriate. Why would Albania refuse to accept one of its own citizens that should, by our rules and our laws, be returned to that country? If it refuses to do so, we would absolutely consider that to an appropriate trigger for that response.
To continue what I was saying, new clause 40 amends section 70 of the Nationality and Borders Act, and it expands the Act to cover both nationals as well as citizens. We consider that it should be a basic and fundamental principle that we should be able to remove from this country those who break our rules. That is harder than it might sound, particularly when individuals are determined to lose their documents and obfuscate their identity and origin in every way they can. What we propose here will align other countries’ incentives with our own. It will create substantial pressure on other nations to co-operate with us to secure our border, and we strongly hope that the Government will consider adding it to the Bill.
Dame Angela Eagle
New clauses 34 and 42 reprise some of our debate on the last group of new clauses, but they also introduce the idea of the visa penalty that, as the hon. Member for Weald of Kent has just explained, is encompassed in new clause 42. New clause 34 seeks to extend automatic deportation to any foreign national convicted of an offence in the UK, or charged with an immigration offence, without consideration of their human rights. We dealt with some of that in the last debate. It would remove protections for under-18s and victims of human trafficking, and it seeks to extend the automatic deportation provisions to certain Commonwealth and Irish citizens who are currently afforded exemption from deportation.
I do not believe these new clauses would be workable. They are unrealistic and would undermine our international obligations. We already have the power to deport any foreign national on the grounds that doing so would be conducive to the public good, regardless of whether they have had to serve the 12-month prison sentence that the UK Borders Act 2007 requires. If they are subject to a 12-month prison sentence, it is a duty to deport them.
The hon. Member for Weald of Kent was a special adviser in the Home Office, so she knows about these things, and the hon. Member for Stockton West is a spokesperson in the shadow Home Office team. The Conservatives talk a lot about deportation, but they did not do a lot about it when they had the power to do so.
Matt Vickers
We wish to divide on new clause 34.
Question put, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following:
New clause 39—Restrictions on visas and grants of indefinite leave to remain—
“(1) Within six months of the passing of this Act, the Secretary of State must by immigration rules provide for all visa grants, including spousal visas, to be conditional on the following—
(a) the requirement that the applicant or their dependents will not apply for any form of ‘social protection’ (including housing) from the UK Government or a local authority, where ‘social protection’ is defined according to the Treasury’s Public Expenditure Statistical Analyses, subject to any further definition by immigration rules,
(b) the requirement that the applicant’s annual income must not fall below £38,700 (or six months or more in aggregate) during the relevant qualification period.
(2) Immigration Rules made under subsection (1) must ensure that any breach of the conditions set out in that subsection will render void any visa previously granted.
(3) The Secretary of State is not permitted to grant leave outside the immigration rules or immigration acts.
(4) A person is not eligible to apply for indefinite leave to remain in the United Kingdom if any of the following conditions apply.
(5) Condition 1 is that a person is a ‘foreign criminal’ under section 32 of the UK Borders Act 2007.
(6) Condition 2 is that a person, or any of their dependents, has been in receipt of any form of ‘social protection’ (including housing) from the UK Government or a local authority, where ‘social protection’ is defined according to the Treasury’s Public Expenditure Statistical Analyses, subject to any further definition by immigration rules.
(7) Condition 3 is that a person’s annual income has fallen below £38,700 for six months or more in aggregate during the relevant qualification period.
(8) A person who has entered the United Kingdom—
(a) under the Ukraine visa schemes;
(b) under the Afghan Citizens Resettlement Scheme;
(c) under the Afghan Relocations and Assistance Policy; or
(d) on a British National Overseas visa,
is exempt from the requirements of Condition 2 and Condition 3.
(9) For the purposes of subsections (1)(b) and (7)—
(a) the condition applies only to earnings that have been lawfully reported to, or subject to withholding tax by, HM Revenue and Customs; and
(b) the relevant sum of annual income must be adjusted annually by the Secretary of State through immigration rules to reflect inflation.
(10) The Secretary of State may by immigration rules make further provision varying these conditions, including by way of transitional provisions.”
This new clause would place certain minimum restrictions on the granting of visas or indefinite leave to remain. It would require migrants to be self-sufficient and do not require state benefits, and would deny ILR to foreign criminals.
New clause 40—Cap on number of entrants—
“(1) Within six months of the passing of this Act, the Secretary of State must make regulations specifying the total maximum number of persons who may enter the United Kingdom annually across all non-visitor visa routes, with such regulations subject to approval by both Houses.
(2) The Secretary of State may by regulations also specify a maximum number of entrants for individual visa routes, subject to the overall total.
(3) No visas may be issued in excess of the total maximum number specified in subsection (1).
(4) Any visas issued in excess of the number specified in subsection (1) must be revoked.”
This new clause would provide a mechanism for a binding annual cap on the number of non-visitor visas issued by the UK.
Matt Vickers
New clause 35 would require the Secretary of State to specify a cap on the number of spouses or civil partners who may enter the UK and on the number who may enter from any one country. It would also amend the immigration rules to set a salary threshold. We know that there is abuse of the current provisions that allow spouses or civil partners to come to the UK. Our amendment is designed to tighten up the rules so as to make abuse less likely.
We believe that it is important for the Secretary of State to set a cap for the number of people who can enter the UK as a spouse or civil partner, and that the number of persons from any one country who enter as a spouse or civil partner of a sponsor should not exceed 7% of the maximum number specified. We seek to tighten up that route to entering the UK by ensuring that the applicant provides evidence that the parties under subsection (9)(a) were married or formed a civil partnership at least two years prior to the application; that each of the parties intends to live permanently with the other as spouse or civil partner, and the marriage or civil partnership is subsisting; that the salary of the person who has a right to abode in the UK, or indefinite leave to enter or remain in the United Kingdom, equals or exceeds £38,700 per year; and that people cannot sponsor their first cousins under this route.
We believe those changes are necessary to ensure that the relationship is genuine and subsisting, and that the sponsor is able to support their partner once they arrive in the UK. That is part of ensuring that we treat living in this country as a privilege, not a right, and that those coming to the UK to live will contribute to our country.
New clause 39 would place restrictions on the granting of visas and indefinite leave to remain. That is another change to achieve our objective that those who come to the UK are able to contribute. The new clause would ensure that visas were granted only where an applicant or their dependants will not apply for any form of social protection, including housing from the UK Government or a local authority, and where the applicant’s annual income will not fall below £38,700 during the relevant qualification period. If either of those conditions fails to be met, the visa will be revoked.
The new clause also specifies that a person cannot qualify for indefinite leave to remain if they are a “foreign criminal” under section 32 of the UK Borders Act 2007; if they or any of their dependants have been in receipt of any form of social protection from the UK Government or local authority; or if their annual income has fallen below £38,700 for six months or more in aggregate during the relevant qualification period. The new clause would not apply to those who have come to the UK through the Ukraine, Afghan or British national overseas schemes.
New clause 40 would introduce some accountability for this place in the overall numbers of migrants coming to the UK per year. It would establish a mechanism whereby Parliament would approve a binding cap on all non-visitor visa routes set out by the Secretary of State. We believe it is important that the House seriously considers the benefits and trade-offs to this country. The new clause is designed to give the House greater accountability for that decision.
New clauses 35 and 39 would build a wall against the quiet epidemic of immigration fraud that has been seeping through our spousal and visa routes—think of sham marriages brokered for £10,000 a pop, or visa overstayers masked by flimsy claims of support. The two-year marriage rule, the £38,700 threshold and the “no first cousin” clause are not just hurdles; they are detectors rooting out paper partnerships before they drain us dry.
The new clauses would anchor immigration to a bedrock of self-reliance, because a Britain that thrives does not prop up newcomers who cannot stand alone. In new clause 35, the £38,700 sponsor salary, which matches that for the skilled worker route, would ensure that thousands of spousal entrants yearly would not tip the welfare scales further. New clause 39 would double down, barring visas and indefinite leave to remain for anyone who dips below that level or taps social housing, for which 1.2 million people are already waiting. This is not exclusion; it is economics, tilting the balance towards those who lift us, not those who lean on us.
New clause 40 is not just a cap; it hands the House the reins of our migration system. The new clause would make Parliament the arbiter, through a binding cap debated here, voted on here, owned here and on which we are fully held to account by the electorate.
Katie Lam
There are few things in life and in human nature more powerful than the desire to be with those we love. To be separated from a husband or wife by a national border is no small thing. Indeed, for those it is happening to, it can feel like everything. But the role of Government is to determine what is right for the country, not for any one person, couple or family. We must place this discussion in its national context. For too long immigration has been too high, and the spousal visa route is increasingly being used by those who would otherwise not be able to come to Britain.
Over the past few years we have seen the number of dependent visas balloon. As of December 2024, 51,000 migrants, bringing 130,000 dependants with them, had come to Britain via the health and social care route over the previous year. That is over 2.5 dependants per health and social care worker—dependants who will access public services in their own right, including our already overstretched NHS. The dependant route for health and social care visa holders has since been restricted, but I mention it because it indicates the huge level of demand and desire there is for family members to come to Britain.
Katie Lam
I think and hope that it has been clear from everything I have said that I make no defence of the previous Government’s activity. It is incredibly important that Conservative Members are able—as is our duty and our responsibility to the public—to talk about the many things that went wrong and, I hope, to help this Government to avoid making the same mistakes.
Katie Lam
As I have set out already, there was never what we are talking about here, which is a formal cap set by Parliament in legislation. However, a number of aims and promises were given to the electorate over the years, and those promises were not kept.
Selective, limited and tailored to our needs—that is the immigration system that the British public have voted for time and again. If we are serious about delivering it, we must take steps to ensure that future Governments do not renege on their promises as previous Governments have. But this is not just about delivering the immigration system that the British people have voted for repeatedly; fundamentally, it is about public trust and accountability.
Put simply, a hard numerical cap on the number of visas issued each year would force Government and Parliament to have accountability for their immigration decisions. If we believe that the overall level of immigration is too high, we should set the cap accordingly, to ensure that technical mistakes do not produce the kind of migration wave that we have seen over the past few years. If we believe that the overall level of immigration is too low, we should be willing to say that publicly, to explain our reasons and to defend our record. Either way, we must be transparent. That will not rebuild public trust in our political system overnight, but it will represent a significant step in the right direction.
Tom Hayes
In a previous sitting, the hon. Lady talked to the hon. Member for Perth and Kinross-shire about humanitarian, and safe and legal routes. She highlighted the difficulty that humanitarian events often happen without warning or anticipation. Our country and others will respond as quickly as possible, and one response might be to open a safe and legal route. Do the Opposition new clauses take account of any possible scenarios, recognising that it is hard to anticipate them? Is there any flexibility in the numbers that she provides for the visa category that would support people coming in who are refugees and people in genuine need?
Katie Lam
As the hon. Gentleman can read in the new clause, the wording does not state that the caps have to be set and cannot be revised; it is more than possible to come back to Parliament to change them. If such a situation arises—he is totally right to say that many of them are emergencies and may have been unforeseeable—there is no reason why that case should not be made to the British public and the cap changed. We are talking here about the need for that case to be made to the British public and for there to be transparency.
Some Labour Members have mentioned my time at the Home Office, where I was a special adviser. I worked primarily on national security, not on legal migration, but it was very clear to me from what I could see of the problems that all my colleagues were facing that most of Government—most Departments, and the Minister may be experiencing this now—are geared for higher levels of migration. For example, it is helpful for the Department of Health and Social Care to have high volumes of health and social care visas issued, or for the Treasury, which issues gilts based on our overall GDP, to have as many people here as possible.
The purpose of the cap would be to bring those conversations out into the open. If those Departments and Ministers wished to justify to the public, to the British people, why those numbers needed to be higher, that conversation should be had where the British people can hear it.
Tom Hayes
New clause 40 mentions the Secretary of State making
“regulations specifying the total maximum number of persons who may enter the United Kingdom annually”
within six months of the passing of this Bill. I assume that the hon. Lady is saying that a statement may be made providing for the annual cap per visa category, over, say, four or five years, and not that the Secretary of State would have to come back each year. Am I right or wrong in thinking that? Could she clarify that?
Katie Lam
The hon. Member asks a good question. I am not sure whether that would be explicitly decided on the face of the Bill; that could be something that the Home Office decided subsequently—whether it wished to set out future years or just the following one. In my initial response to the hon. Member, the point that I was trying to clarify was that that cap can, of course, be changed. Once it is set, it does not need to be set in stone for ever, but it is important that it exists and that the conversation about what it should be is had in front of the British public.
Chris Murray
It was interesting to hear the hon. Member for Weald of Kent setting out her argument articulately, and it was good to hear her say that she recognises that the last Government made a lot of mistakes on immigration, and that the evidence shows that. Sadly, although it is good to have that recognition, it does not seem as though very much has been learned from the Conservatives’ experience in office, based on each of the new clauses that they have set out.
First, on the spousal visas, quite a lot of what is in new clause 35 actually exists already. There are already salary thresholds and things like that. It is unlike me to praise the previous Conservative Government on immigration, but, actually, across previous Administrations, both Labour and Conservative, very good work has been done on issues such as sham and forced marriages. What is new in new clause 35, which is a very strange and horrible power to give Ministers, is the ability to either restrict the nationalities that British people can marry or set thresholds on them. I have huge respect for my ministerial colleagues in the Home Office, but I do not think that they should be able to choose what nationalities I am allowed to marry. We got rid of anti-miscegenation laws in the 20th century; we do not want returning through the back door, through measures such as this. Most of all, this arbitrary figure of 7% is very strange; if I were to marry, say, an Australian or an American, I would have to hope that I was not in the 8th percentile of people to do that. That would be a very strange way for us to ask British citizens to live their lives and fall in love with people.
Opposition Members also made the point about how the legislation needs to look backwards and make sure that migrants are net fiscal contributors over their lifetimes. I would say, again, that that is not a realistic thing to ask Governments to do. We will only know whether we have been net fiscal contributors when we die, so we cannot really ask people to make those projections.
Finally, there is the numerical visa cap in new clause 40. Again, that is a gimmick that is not addressing the actual structural problems in the immigration system. First, it treats all migrants the same, as one big monolithic whole, yet we know that the impact of migrants on communities is different, whether they are spouses, students, doctors, lorry drivers or refugees.
If we are going to have this kind of cap, how do we prioritise? Will it apply throughout the whole of the year? How will businesses plan if they want to recruit from overseas? As my hon. Friend the Member for Bournemouth East said, what if emergencies mean that there are more people coming in? The last Conservative Government set a cap for tier 2 visas, then, of course, ended up hitting it and just exempting doctors and nurses from it anyway. Is it not inevitable that we will just be condemned to repeat history if we do that here? We have talked a lot about public trust in the immigration system and how that has been so deeply sapped by failures on immigration policy. The Conservatives had a net migration target of 100,000 a year, which they consistently failed to meet and had to revise. This proposal is just advocating that we repeat that exact mistake, but hoping for a different outcome, which seems bonkers to me.
Seema Malhotra
A number of the issues raised regarding these new clauses have already been debated in relation to other measures, so I will keep my remarks fairly brief on some of the additional issues.
Matt Vickers
We think it is right that there should be limits on the number of people who can arrive here as a spouse or partner, a requirement on those bringing people to be able to support themselves, and a cap on the number of people entering the country. We wish to press the new clause to a Division.
Question put, That the clause be read a Second time.
Matt Vickers
I beg to move, That the clause be read a Second time.
The new clause is vital to giving immigration enforcement the powers it needs to smash the gangs and tackle any criminality surrounding those who arrive here illegally. It would give immigration enforcement access to asylum accommodation centres. Currently, there are limitations around the detention of those arriving illegally on small boats. These limitations arise from a lack of statutory power, as well as a lack of state capacity to detain those arriving illegally.
In government, the Conservative Administration set up accommodation centres, which provided a plausible alternative to hotels. Because the centres were not used to make immigration decisions, in practice immigration enforcement officers did not find it possible to enter them for the purposes of examining, arresting and detaining persons residing therein for the purposes of refusal and removal.
Tony Smith, the former director general of UK Border Force, has powerfully argued that immigration enforcement teams must have clear authority to enter all places where asylum seekers are residing to examine, interview, arrest or detain them as appropriate. The Opposition agree wholeheartedly, for these would be proportionate powers for the state to use to enforce the law. Currently, centres housing thousands of small boat arrivals are not detention hubs. Instead, they are in effect halfway houses between the point of processing and where decisions can be made. Consequently, there is a substantial asylum backlog, which has created bottlenecks in the system. This is simply inadequate for everyone involved. It cannot continue, and it must stop.
The new clause therefore tries to end this predicament and failure in the system. Enforcement cannot be allowed to be bereft of action, unable to chase absconders who vanish into the ether without a trace. We need to empower officers to go into these sites to interview, arrest and detain where appropriate. That would allow faster decisions, faster refusals and quicker removals. The clause would not only mean a more efficient system that saves hardworking taxpayers’ money, but help decimate the business model of the people-smuggling trade. In just the last two years, traffickers have accumulated hundreds of thousands, if not millions of pounds in profit. We all know the tragic consequences of people who have made this life-threatening journey.
We must, at all costs, undermine the business model of the people smugglers. That is the truly compassionate thing to do, so I am proud to support clause 36 because it eliminates gaps in our asylum enforcement system, ends centres being off limits and hence makes it much more difficult for people to get lost in the system. So we have to act, and act now. As such, clause 36 appears to be common sense, allowing our enforcement agencies the access that the average person would probably assume they already have. Does the Minister think an amendment or power such as this would be of operational benefit to immigration enforcement, and if not, why not?
Pete Wishart
I do not want to detain the Committee for long with this amendment, but this is just another abhorrent amendment from the warped imagination of the Conservative party. I do not know where they come up with things like this. They would have to be very creative and very cruel to propose something quite like this. The amendment would allow immigration enforcement officers to visit accommodation centres at any time without prior notice. Asylum seekers and other residents at these centres are often fleeing persecution, war and violence and will have suffered severe trauma. The constant threat of unannounced visits from immigration enforcement will create an atmosphere of fear, making it even more difficult for individuals to feel safe.
Allowing immigration enforcement to visit any resident at any time is a clear violation of privacy. It undermines their dignity and wellbeing and could lead to harassment or increased surveillance, further marginalising already vulnerable populations. Vulnerable individuals should not be made to feel constantly watched or threatened by authorities, especially when they are seeking safety and stability. The presence of immigration enforcement officers may discourage asylum seekers and migrants from seeking support or reporting issues of abuse, exploitation or trafficking. All this could do is undermine the very support structures designed to help individuals rebuild their lives in the UK.
The amendment lacks any clear safeguards or accountability mechanisms for how immigration enforcement would operate, and I urge the Committee to reject it. I hope it rejects the rest of the Conservative party’s amendments, too.
Katie Lam
New clause 36 would give access to asylum accommodation centres to our immigration enforcement officers. Members of the public may be surprised to learn that this power does not already exist. It seems to me common sense that when a person has come here illegally and is being housed by the state, immigration enforcement—an arm of that state—should be able to enter that accommodation to carry out their work.
As my hon. Friend the Member for Stockton West rightly set out, these accommodation centres exist because the volume of those coming here illegally is such that it is not possible to hold everyone in immigration detention. There are therefore substantial numbers of people on immigration bail, and a reasonable number of those are held in accommodation centres. Immigration decisions are made elsewhere, but this is the criterion set out in current legislation. In our view, this is a quirk of the current system, and not how one would design it if starting from a blank page. These sorts of accommodation centres did not exist when our rules were written, and we think that this corrects that quirk.
I echo the question asked by my hon. Friend the Member for Stockton West: does the Minister think that this would be of operational benefit to immigration enforcement officers? If so, will she include it, and if not, why not?
Dame Angela Eagle
New clause 36 seeks to provide a right of access upon request for Home Office teams working within immigration enforcement to asylum accommodation centres in order to visit those centres and residents at any time.
Matt Vickers
I think the public will be stunned to hear that immigration enforcement officers have challenges in accessing asylum accommodation centres, as outlined by Tony Smith, the former director general of UK Border Force. We will therefore seek to press the new clause to a vote.
Dame Angela Eagle
The new clause talks about accommodation centres, which do not exist. What does the hon. Gentleman mean by accommodation centres?
Martin Vickers
We have had provision for accommodation centres. We have had accommodation centres.
Martin Vickers
I know there are 8,500 more in hotels now, but this was a measure that was put in place to reduce that hotel dependency, to stop us increasing the number of people in those hotels by 29%.
Dame Angela Eagle
I want to put something on the record before we vote. There is a specific meaning in law for the phrase “accommodation centres” under the Nationality, Immigration and Asylum Act 2002. Since that law was passed, no Government have actually stood up accommodation centres under that specific meaning. Therefore, the shadow Minister in his new clause 36 is asking for powers to enter something that does not exist.
Pete Wishart
While the Minister is on her feet, could she perhaps ask the Opposition spokesperson whether he actually means hotels?
Dame Angela Eagle
I thank the hon. Gentleman for that. I was trying to help the shadow Minister, because I thought he might be trying to talk about accommodation generally. If that is the case, we already have the powers we need to enter when and where we wish. This power is much broader, and we would not like to see it put into effect, which is why I hope the Committee will vote against the new clause.
Question put, That the clause be read a Second time.
Matt Vickers
I beg to move, That the clause be read a Second time.
The Immigration and Asylum Act 1999 and the Asylum Support Regulations 2000 enable asylum seekers to obtain housing and funds to support themselves while they wait to find out whether they will get asylum. Their children can attend state schools and they are entitled to NHS care. We know that asylum seekers crossing the channel in small boats are often given bail and provided with asylum support. Those with no UK address will be allocated asylum housing, or placed in asylum hotels or accommodation centres. The National Audit Office has estimated that the cost of this to the taxpayer was around £4.7 billion in 2023-24.
Matt Vickers
We have had many alternative means of accommodation, including hotels. Accommodation of asylum seekers in hotels is through the roof—it is up 29%, with 8,500 more people staying in them—but the situation I am describing applies more widely than any accommodation centre or hotel.
The £4.7 billion tab for 2023-24 covered beds, meals and NHS visits while the backlog ballooned.
Chris Murray
Will the hon. Gentleman accept that that number has “ballooned”—or gone up highly—not just in the aggregate but per asylum seeker? The hon. Gentleman wants to try to charge people, but his party let the system get completely out of control. Maybe it was the backlog that let it get out of control, rather than the kind of hotels that people were staying in.
Matt Vickers
The reality is that somebody is getting charged for it and paying for it, and at the moment that is the Great British public. There are ballooning costs. There are increasing numbers: illegal arrivals are up 28% since the election, there are 29% more people in hotels, and fewer of the people who arrive illegally are being removed. The number goes up, the cost continues to go up, and somebody has to pick up the tab. Making the person repay those costs once they are working—with, say, £10,000 over a decade—could claw back hundreds of thousands of pounds. That is not small change: it is classrooms built, potholes filled and nurses hired. Why are the Government content to let this sinkhole drain us dry when we could balance the books with a system that asks those who are successful to pay back some of these costs?
In his evidence, Tony Smith highlighted the knowledge that such support is available as a pull factor that encourages people to cross the channel. We share Tony Smith’s view that making it clear that the costs of asylum support and accommodation will be recovered once the applicant is economically active could help to disincentivise future crossings. That is why we have tabled new clause 37.
The proposed new clause would enable the Government to treat asylum support like a student loan, with asylum seekers able to pay back the cost of support when they are in paid employment. We believe that if someone’s asylum appeal is granted and they are allowed to remain in this country and they are able to work, they should be required to pay back to the state the costs of their maintenance, as and when they are able. State support is not a right.
Tom Hayes
This may be our last sitting day; I say this in hopes that it is. Over the last few sittings, having not known the hon. Member for Stockton West, I have grown in admiration for him, because he has had to defend very difficult things from the previous Government. It has felt like he is a goalkeeper standing in front of goal without any gloves on, and balls have been hit at him from every direction, so I do have admiration for him. But this is frankly absurd—it really is bonkers. Is this the hon. Member’s idea, or is it somebody else’s idea that he is having to make a case for? I really hope it is the latter.
Matt Vickers
To the hon. Gentleman’s electors and mine, these things come at huge cost. As we have set out, that money could be used by the people who pay in to the system, and have done for a very long time. We have drawn an analogy with student tuition fees and I think it is very relevant. I am grateful for the hon. Gentleman’s well-hidden admiration in recent times, but I think this is the right thing to do, and I am well on board with it. State support is not a right, and if a person is able to contribute later by paying some of that back, we believe it is right for them to do so.
Katie Lam
We have spoken many times today, and over the course of this Bill Committee’s proceedings, about the fundamental principles of fairness upon which we believe that our immigration system should be built. We have also spoken extensively about the generosity of the British state, and how much it costs to support those who, according to our rules, cannot support themselves. But that generosity, while admirable in what it says about our approach to our fellow man, costs the British taxpayer dearly. As my hon. Friend the Member for Stockton West set out, it costs many billions of pounds a year. It also causes additional pressure on infrastructure and public services, which is not covered by what we suggest here.
We consider that new clause 37, which would introduce the asylum support repayment scheme, is a totally fair way of proposing that people who come to this country are responsible for contributing for the services that they receive. That includes the accommodation that they live in. We do not see any reason why that should be viewed as a negative change, and we really hope that the Government include it in their Bill.
Dame Angela Eagle
New clause 37 would give the Secretary of State regulation-making powers to set out arrangements for asylum seekers to receive loans towards their maintenance and accommodation—but, as we have discussed in this Committee during scrutiny of the Bill, the costs of accommodating and supporting asylum seekers has grown significantly. The reason for that increase is that the Government inherited an asylum system under exceptional strain, with tens of thousands of cases previously at a complete standstill—the perma-backlog, which we have referred to on many occasions during our proceedings in the past few weeks—claims not being processed, and a record number of people having arrived on small boats in the first half of the year.
While immediate action was taken to restart asylum processing, we cannot resolve the situation overnight. It nevertheless remains our commitment to reduce the cost of asylum accommodation, including by ending the use of asylum hotels. The size of the existing backlog, particularly in appeals, means that we are forced to use hotels in the meantime. That is not a permanent solution, but it is a necessary and temporary step to ensure that the system does not buckle under exceptional strain.
Increasing the speed at which asylum claims can be processed and dealt with is the best way of dealing with this issue of cost, in my view. I think on all sides we want to see the costs come down. We want to see a properly functioning immigration system that delivers fair, timely decisions and manages public funds. Hotel costs have actually dropped from over £9 million a day to under £6 million a day. Overall the Department is planning to deliver £200 million of additional in-year savings in 2024-25, and £700 million of savings against 2024-25 levels during the following financial year, on asylum costs. These measures, taken together, would represent a saving of over £4 billion across 2024-25 and 2025-26 when compared with the previous trajectory of spending.
The Home Office has a legal obligation, as set out in the Immigration and Asylum Act 1999, to support asylum seekers—including any dependants—who would otherwise be destitute: “destitute” is the word that people need to remember there. Asylum seekers can apply for accommodation, subsistence, or both accommodation and subsistence support when they are destitute. Once official refugee status has been given, the individual is able to work in the UK.
Although asylum seekers generally do not have the right to work in the UK while they are waiting on a decision about their asylum claim, there are some instances in which they can apply for permission to work. They are eligible to do so if they have waited over 12 months for an initial decision on their asylum claim, or for a response to a further submission for asylum, and they are not considered responsible for the delay in decision making.
In that context, the new clause proposed by the hon. Member for Stockton West is an interesting one. I would welcome clarification on how such a loan scheme would operate alongside or instead of the current system, and the details of any assessment of the practical or economic benefit of such a scheme. Further scoping would be necessary in order to establish whether it is a feasible option. As such, its inclusion in this Bill is premature.
Matt Vickers
The big question is “Who pays?”. There is a huge cost here. I would never seek to get political about the political choices made with funding in recent times—I would not go into the winter fuel payment, or the increase in tuition fees. Tuition fees is an interesting comparator, though, because we ask those who are able to do so to contribute to the costs incurred in delivering them their education. We should be asking people who arrive in this country, who could go on to become very successful, to contribute to some of those costs.
Katie Lam
I welcome the Minister’s response. Might she please commit today to a date by which the Home Office at least aims for all migrant hotels to be closed, as per her party’s manifesto commitments? I also welcome what she had to say about bringing down costs. She is right to say that the best way to minimise the Home Office’s bill for asylum accommodation is to process applications as quickly as possible. Where asylum applications are approved, though, most of those costs transfer to the welfare system, so I would be interested to hear her response on who in Government is currently responsible for tracking and understanding that cost.
Dame Angela Eagle
We inherited a system that was very siloed, where work was not really cross-departmental at all. One example that occurs to me is that the system dealing with all the legacy applications, which the previous Government embarked on dealing with at first-tier tribunal in 2023 and then boasted about having achieved. However, that was only the initial decision in the system; if it was granted, I suppose people felt lucky, but those who were not granted appealed the decision. While the Home Office, under the previous Government, congratulated itself publicly on dealing with that legacy system, many people were actually still in the system.
One important thing we have done since coming into government has been to begin working cross-departmentally to develop metrics on how to deal with an end-to-end system. We are not there yet, and we understand that costs can sometimes be transferred to other areas; that is why I am working closely with the Local Government Association, the Ministry of Housing, Communities and Local Government and the MOJ to try to get the system working more effectively end to end.
I cannot give the hon. Member for Weald of Kent a date on when hotels will close, but I can say that we are doing our best. Given the huge cost and the fact that the contracts for providing them that we inherited from the Conservative party are so expensive, it will certainly be in the interests of saving a lot of money to close them as soon as we can, and we certainly aim to do so.
Katie Lam
Again, rightly and reasonably, the Minister talks about lowering costs, but might she say a few words about fairness and the principle that this new clause seeks to speak to: should those who have lived in that accommodation, who have benefited from that provision by the state, ultimately pay it back, if they can afford to?
Dame Angela Eagle
The hon. Lady will have noticed that I have not dismissed the idea completely, but I do not think the idea is anywhere near a position where one could talk about how it might be practicable, and certainly it is not at a stage where one could consider putting it into primary legislation.
Matt Vickers
State support is not a right and, if a person is able later to contribute by paying some of it back, we believe it is right for them to do so. We wish to press the new clause to a Division.
Question put, That the clause be read a Second time.
Matt Vickers
I beg to move, That the clause be read a Second time.
New clause 38 would require the Government to make changes to arrangements for leave outside the immigration rules. It would require the Secretary of State, within three months of the passing of this Act, to consult on reforms to arrangements for leave outside the immigration rules. The consultation must consider how best to ensure that leave outside the rules is granted only in the most exceptional circumstances, in which a reasonable person would consider it unacceptable to refuse entry to the United Kingdom. Within 18 months of the passing of this Act, the Secretary of State must, by regulations, make changes to the immigration rules to implement the required reforms to leave outside the rules.
We have tabled this new clause because we are concerned about the Government’s response to the recent decision in the upper tribunal to allow a family from Gaza to obtain permission to come to this country using the Ukraine family scheme. The appellants were Palestinians who, at the time of the decision under challenge, were residing in al-Mawasi, the humanitarian zone of Gaza.
The first and second appellants were husband and wife, and had lived in Gaza since 1994. They were the parents of the remaining four appellants, who at the time of the decision were 18, 17, eight and seven years of age. The sponsor for the application was the first appellant’s brother, who had moved to the United Kingdom in 2007 and is now a British citizen.
The first-tier tribunal declined the application and the decision was appealed. The main issues to be decided by the first-tier tribunal were whether there was family life under article 8(1) between the appellants and the sponsor in the UK, whether the respondent’s decision interfered with any family life and/or any private life enjoyed by the sponsor, and whether any such interference was disproportionate.
The upper tribunal did not agree with the Home Office’s argument that the first-tier tribunal judge had erred in finding that there was family life between the appellants and sponsor. It found that there was family life and that the Home Office decision not to allow the family leave outside the rules was a disproportionate interference with the family life of the appellants and the sponsor.
When the Leader of the Opposition challenged the Prime Minister about this particular case at Prime Minister’s questions, he responded that he did not agree with the decision of the upper tribunal, and said that the Government were
“looking at the legal loophole that we need to close in this particular case.” —[Official Report, 12 February 2025; Vol. 762, c. 249.]
The new clause makes a suggestion about what that “legal loophole” might be, but it is extremely important that the Minister is able to answer the following questions. Did the Home Office decide not to appeal the upper tribunal decision? If so, why? What is the legal loophole that the Prime Minister said the Home Secretary was closing? Can the Minister be extremely precise about that, please? Can she explain when the House will be updated on this issue? Finally, if there is a legal loophole to close, why is that not being done through this Bill?
Seema Malhotra
I find this a very interesting debate and an important one in a number of respects. New clause 38 would require a consultation on the Government’s approach to the exercise of discretion to grant leave outside the rules in what any reasonable person would consider to be the most exceptional circumstances to warrant such a grant, with a requirement for a change to the rules to follow, to regulate on the basis of what discretion may have been exercised.
The rules set out the main purposes for which a person may enter or stay in the UK, and the requirements to be met for them to be granted permission to do so. Exceptional circumstances are already considered. The rules are intended to apply, and be applied, in most circumstances to ensure transparency and fairness between individuals, but the existing policy approach recognises that there are some circumstances that they simply cannot cater for, and it is in the most exceptional circumstances that consideration is given to leave outside the rules under the Immigration Act 1971.
A period of leave outside the rules would usually be granted for a short, one-off period of permission to stay, suitable to accommodate or overcome the exceptional circumstance, if compassionate or compelling grounds are raised in the individual case. A person may request an exercise of discretion. Factors considered may be related to, for example, emergencies, unexpected events, a crisis, a disaster, an accident that could not have been anticipated, or a personal tragedy. The Government will continue to consider where and when there is need to exercise discretion outside the rules. By its very nature, that is considered only in the most exceptional of circumstances.
It is probably not appropriate for me to go into the case that the hon. Member for Stockton West raised, beyond what has been said in the House. He asked some very specific questions, and I am happy to come back to him with what I can in writing. It is important to say that this is not the correct legislation for a debate about the requirements for discretion to grant leave outside the immigration rules, nor is it the correct place to define the parts of immigration policy on which the Government should consult.
Matt Vickers
On that case and on the loophole, which Minister does not think is relevant to this legislation, what does she identify that loophole as, and why does she not feel that that broader issue is relevant in considering this Bill?
Seema Malhotra
The shadow Minister understands extremely well that the Bill is about ensuring we stop the criminal gangs and that it introduces new powers to do so. On other new clauses that he tabled, I have given the same response in relation to aspects of the immigration rules. This is not the correct legislation to define parts of immigration policy or to try to determine what the Government should consult on.
As I said, the Government continue to consider where and when there is a need to exercise discretion outside the rules. By its very nature, that is considered in only very exceptional circumstances. I have shared what some of those factors might be: unexpected events, a crisis, an accident that could not have been anticipated, or a personal tragedy. I am sure he understands those matters, considering that he has served in office.
Matt Vickers
This is a valuable and important debate because many people felt strongly about this issue. The decision in that case flew in the face of the values of the Ukraine scheme. It could undermine commitments to future such schemes, so it is of great consequence.
Katie Lam
I am a little confused by the Minister’s stating that several of our amendments should not be debated with this Bill. I fully concede that she is more experienced than I am, but my understanding is that any amendment considered in scope can be tabled, debated and voted on. Given the fact that these amendments were considered in scope, I am interested in why she thinks it is not appropriate for us to discuss them today.
Seema Malhotra
I thank the shadow Minister for her comments. I am not disputing that there can be a debate on them. What I am saying is that the Bill has a clear and defined purpose, and it would not be appropriate to extend it to be more than what it is designed to be when there are other mechanisms by which immigration rules are debated in the House.
Seema Malhotra
I thank the shadow Minister for asking what the Bill is about, but we are just at the end of scrutiny of it, so I am sure she is aware that it is about increasing powers, in particular, to be able to better tackle the criminal gangs that are undermining our border security and putting lives at risk. We are making sure that we have bodies such as the Border Security Command on a statutory footing. We have had many other debates in the House about this.
Matt Vickers
Often with amendments we want to bring things out into the light. One thing I have not quite heard is what the Government are doing in the light of the issues with the Ukraine scheme, in particular to prevent what happened in the case I mentioned from happening again. We have this big borders Bill coming through, which will hopefully be the answer to the world’s problems and improve the situation, but are the Government doing anything about the misapplication of the Ukraine scheme to ensure that the case I mentioned will not happen again?
Seema Malhotra
The hon. Gentleman is right, and the Prime Minister laid out the view that it was the wrong decision. We do need to find a way to tighten up how Parliament understands the rules and how they are interpreted, but as I say, that scheme is not a matter for this Bill. We are at the very end of debating the Bill and now I am being asked what it is for. I am sure that the shadow Ministers do not want to go all the way through the line-by-line debate again. Suffice it to say that the matters they are seeking to extend the legislation to cover stray into broader aspects of immigration that in our view are not appropriate for inclusion in this Bill. There are other mechanisms for us to seek to debate and change immigration rules.
Katie Lam
I thank the Minister for responding to me earlier. The Opposition’s view is that the various ways by which people come here illegally and stay is fundamentally important to smashing the gangs, and that leave outside the rules and the ways it may be abused are a big part of that. That seems to us to be part of the fundamental point that we are discussing. Will the Minister comment on that?
Seema Malhotra
The hon. Lady is right. I have raised a number of times during the debate we have had the ways in which we see routes abused; indeed, the way that routes have been designed has left them open to more abuse. We are now reaping the results of that, in terms of some of the measures and the tightening up that we are doing. She will be aware that we have raised this as a matter that it is important for us to bring under greater control as part of an immigration system that is fit for the future and more controlled, more managed and fairer, and the aspects that we believe can and should be considered for a future immigration system will be the subject of the immigration White Paper. I look forward to debating that with her.
Question put, That the clause be read a Second time.
Matt Vickers
I beg to move, That the clause be read a Second time.
The new clause would require the revocation of asylum or refugee status, or leave to remain, in relation to an applicant who returns to their country of origin, either subsequently or while their application is being processed. It would also apply to people who make an immigration human rights claim.
If an individual has made a claim that being made to return to their country of origin would violate their human rights and put them in danger, then their choosing voluntarily to return to their home country would suggest that something does not add up. Fundamentally, no reasonable person would consider an individual’s returning to their home country to be compatible with their claim for asylum in such circumstances. If a person needs to remain in this country because they have a legitimate fear of persecution in their country of origin, a return to that country of origin fundamentally undercuts that claim.
Pete Wishart
I have studied this measure closely. Conditions change within the countries that people leave, and asylum status and human rights records change accordingly. Is the hon. Gentleman trying to say that there is no reason whatsoever that an asylum seeker may go back to their country of origin and then come back to the UK? What about family emergencies? Surely the Conservatives are not so callous as to suggest that people cannot go back to their country of origin for a family funeral, for example.
Matt Vickers
People arrive in this country out of fear of persecution. People come from the most awful, extreme circumstances. That is the bar that we put to asylum. We allow people to come here to claim asylum out of fear for their welfare, and if they are happy to pack their bags and pop back for a break, then that is on them. I believe, and I think the public would believe, that if someone comes here claiming fear of persecution in their country of origin then they should not be going back. It is not an opt-in or opt-out—it is not a holiday. If they are coming here out of fear of persecution in that country then they should not be going back.
We have tabled new clause 41 in order to address a loophole that people can and do exploit. The new clause would uphold British fairness—a value that welcomes those in need but rejects exploitation. As Members from across the House know, the United Kingdom has supported over 20,000 Afghans since 2021 through the Afghan relocations policy and over 200,000 Ukrainians since 2022 via visa schemes, alongside our Hong Kong friends with British national overseas visas, backed further by £4.7 billion in asylum costs in 2023-24. These commitments reflect our readiness to help those with genuine cases—those fleeing real danger who have ties to Britain. The value of fairness demands a fair system that is not abused.
Matt Vickers
We are talking about all sorts of circumstances, and I am sure that every one of these things would be pushed to the max, with lots of discussion and debate. The idea here is the principle that if someone cannot be in a country because it would be to their detriment and damage their wellbeing, then they should not be going back. If it is such a security threat that they need to come to the UK for asylum—
Matt Vickers
People who claim asylum arrive here from some of the most terrible, awful circumstances—their life is threatened and they are at real risk. If someone is at that level of risk, on the balance of probabilities, they would not be going back. If someone fears persecution in the way that many of the people who get asylum in this country do, then they would not be returning.
Pete Wishart
We really cannot let them away with this, because it is just cruelty personified. Would the hon. Gentleman not make every effort and take every risk to return to his country of origin if it were the funeral of his mother or father?
Matt Vickers
I hear what hon. Members are saying, but in the current system we allow people to pop back on holiday. Is that acceptable?
Matt Vickers
I am talking about those circumstances. We have heard one extreme; at the other extreme, we have people claiming asylum at huge cost. That is not a cost to well-heeled people, in particular, but to British taxpayers, some of whom are struggling to get by, but are contributing to this country and this system, which pays out for various other things. We want to be generous. We want to support the people who need that help. It is the right thing to do and, I have just outlined, we have done that. But we cannot allow that generosity to be abused; we cannot allow people to pop off on holiday back to wherever they came from and then come back. That is the principle that is at stake here. People out there feel that it is very unfair that people pop back, and use asylum here as something hotel-like. That is the other extreme. That is the abuse that we are seeing, and that is what the new clause aims to end.
Tom Hayes
Does the hon. Gentleman recognise that the Hongkonger population would be very disheartened to hear what he is saying? Does he think it is right for him to stick to what he is saying? Would it not be better to show some sympathy to that particular population who are here?
Matt Vickers
I show lots of sympathy. It is right that we have put all these schemes in place, and it is right that we are supporting these people in the way we are. I also think a little bit about what the British people would think about what I am saying, and the abuse they are seeing of these schemes that allow people to pop back to other countries for various reasons. The hon. Gentleman has given one extreme; I have given the other. I think that is a principle that the British public would be on board with.
Katie Lam
Throughout our long history, Britain has been an unusually compassionate place. From time to time, people have come to this country to seek sanctuary from tyranny and authoritarianism elsewhere in the world. My county of Kent became home to many of the Huguenots who fled religious persecution in France in the 16th century. Indeed, Canterbury cathedral still hosts a French-language service every Sunday, in honour of those who came to this country in search of tolerance and religious freedom.
My grandmother came to Britain in 1937 at the age of 13, as a refugee from Germany. Her grandfather was a state senator and a fierce critic of the Nazis. When Hitler came to power, the whole family were stripped of their citizenship and several were arrested. After years imprisoned and various daring prison escapes, the family first made it over the border to Czechoslovakia, where they set up a resistance radio station broadcasting back into Germany. One night, that was raided by the SS and one of the operators was shot dead. They then fled to England and to freedom.
We should be proud of our history. There are so many Brits like me who would not be here and would never have been born without the past generosity of this great country. But as I said earlier, we must also be realistic about the very many ways in which our system can be exploited by the cynical and the sinister. There are, of course, people who come to these shores legitimately seeking asylum, but we must also be honest about the fact that not everyone who comes to this country and applies for asylum has a legitimate case for doing so. We can see that evidenced in the fact that not all claims are approved.
Too often, asylum is used as an immigration route for those who otherwise would not be able to come here. Our compassion is therefore exploited by those who are in no real danger at all, a sad truth made clear by the fact that many would-be asylum seekers regularly return home without issue. The bar to claiming asylum should rightly be high. People should be in serious danger in their home country to qualify. Government Members are right to say that the new clause might cause difficult and, in some instances, heartrending situations, but that in and of itself does not make it the wrong thing to do.
Last December, as I mentioned earlier when discussing our human rights legislation, a Turkish heroin dealer was allowed to stay in the UK after first seeking asylum here in 1988. Despite claiming that he would be persecuted in his home country, the man had returned to Turkey at least eight times since arriving in Britain. On one of those trips, he even got married to a woman with whom he had been having an affair, despite already being married with children in the UK. Nevertheless, he escaped deportation, as it was ruled that deporting him would interfere with his right to a family life. That kind of scenario is clearly wrong and contributes to the persistent feeling that so many ordinary British people have that our asylum system is broken and unfair.
Dame Angela Eagle
New clause 41 would require the revocation of protection status or leave, or discontinuation of asylum claims, where an applicant returns to their country of origin. The Government are in absolute agreement on the principle behind the new clause. Although we are committed to providing protection to those who genuinely need it for as long as it is needed, in accordance with our obligations under the refugee convention and the European convention on human rights, such protection status must be granted only when it is required. As such, I want to reassure Opposition Members that, under our existing policy, where an individual returns to their country of origin, we consider whether they have re-availed themselves of the protection of that country. Where that is the case, we seek to revoke their protection status under the appropriate provision set out in the immigration rules.
We are also clear that asylum claims may be discontinued and withdrawn where the applicant fails to comply with the asylum process, which includes leaving the UK before a decision is made on their claim. I hope Opposition Members are therefore assured that the immigration rules enable protection status to be revoked already and applications to be discontinued where an applicant has returned to their country of origin. As such, new clause 41 is not required.
Matt Vickers
We wish to press the new clause to a Division.
Question put, That the clause be read a Second time.
Katie Lam
I beg to move, That the clause be read a Second time.
This is a probing amendment tabled by the Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), to tease out what he feels are important issues to discuss in the context of the Bill. I would like to make it very clear that the Opposition are neither supporting nor opposing this new clause. Ideally, my hon. Friend the Member for South Northamptonshire would have spoken to this new clause, but she has Parliament-related business elsewhere today, so I am standing in.
The background to the new clause is that various international treaties impose, or have been interpreted as imposing, an obligation on states not to send people back to a country where they would face harm. This is known as non-refoulement. However, not all non-refoulement obligations are the same, and there are important differences. The new clause seeks to tease out the differences between the ECHR on the one hand, and the refugee convention and torture convention on the other. One key difference is whether there are any exceptions to the principle of non-refoulement, which is to say: are there any circumstances in which someone can be sent back to a country where they would face a real risk of relevant harm?
Under the refugee convention, the obligation not to refoul is not absolute; it is subject broadly to two exceptions. The first of those is the article 1F exclusion from protection of the refugee convention. That exclusion applies to those who have committed war crimes, crimes against humanity, serious non-political crimes abroad and acts contrary to the purposes of the United Nations. The second exception is provided for in article 33(2), which concerns those who pose serious risk to the security of the host country and those who have been convicted of particularly serious crimes, and therefore pose a danger to the community of the host country.
As the UNHCR said in respect of article 1F exclusions, the rationale is that certain acts are so grave as to render their perpetrators undeserving of international protection as refugees. The Court of Justice of the European Union has said that its purpose is to maintain the credibility of the protection system, and as Professors Hathaway and Foster have noted, the realpolitik reason was that the drafters of the refugee convention were persuaded that if states parties were expected to admit serious criminals as refugees, they would simply not be willing to be bound by the convention.
The same is presumably true of the article 33(2) exceptions. It would be surprising if states would have been willing to sign up to a duty not to refoul if there were not that exception for those who were a threat to their countries. In 1987, the UN convention against torture came into force. It now has 173 states parties. Article 3 of the torture convention provided for an absolute non-refoulement rule in cases of torture.
Although the convention also dealt with cruel, inhumane and degrading treatments, states were careful to limit the absolute non-refoulement rule to torture. The result is that even if an individual falls in the scope of article 1F or article 33(2) of the refugee convention but would face a real danger of torture, they cannot be removed. It was felt by states that torture was such an absolute evil that the credibility of the international protection system would be undermined by preventing the removal of such individuals if they faced torture.
While the refugee convention and the torture convention both explicitly addressed non-refoulement, the ECHR did not. It prohibits states from engaging in torture or cruel, inhumane and degrading treatment, but it says nothing about refoulement. That is not surprising, as the ECHR was drafted at the same time as the refugee convention, and arguably it was felt that those issues were best addressed by the refugee convention. None the less, in the late 1980s, the Strasbourg court interpreted article 3 as prohibiting refoulement. It did so not just for torture, but for all forms of treatment contrary to article 3, and it held that the rule was absolute. As the court put it:
“The conduct of the person concerned, however undesirable or dangerous, cannot be taken into account.”
The consequence is that the protection afforded by article 3 is broader than that provided for in articles 32 and 33 of the 1951 United Nations convention relating to the status of refugees. That interpretation by the Strasbourg court completely negated the careful balance struck by the international community with the refugee convention and torture convention.
The new clause posits that that interpretation threatens the legitimacy of international human rights law and that the conclusion by Strasbourg is the means by which that happens. The KM case provides a good illustration. KM was a police officer in the Democratic Republic of Congo. He entered the UK illegally in 2012 and applied for asylum. His application was refused by the Home Secretary on the grounds that he had been involved in torture. The upper tribunal upheld that finding and held that he should be excluded from protection under article 1F of the refugee convention. However, because of article 3 of the ECHR, as interpreted by the Strasbourg court, he could not be removed.
There are many more cases of serious criminals and terrorists—people who are a threat to those who live in the UK—who could be deported under article 33(2) of the refugee convention but cannot due to article 3 of the ECHR. In Saadi v. Italy, two Strasbourg judges wrote that they would not be surprised if some citizens of Europe
“find it difficult to understand that the Court by emphasising the absolute nature of Article 3 seems to afford more protection to the non-national applicant who has been found guilty of terrorist-related crimes than to the protection of the community as a whole from terrorist violence.”
Indeed, the Father of the House, were he here, would say that he suspects that the vast majority of Britons and Europeans would be baffled by that conclusion. That is also precisely the reason why the drafters of the refugee convention saw fit to include exceptions for criminals and terrorists: they knew that with rights come responsibilities, and that those who act in this way completely violate the social contract and cannot properly claim its protection. The interpretation that Strasbourg has given has, in the view of the Father of the House—at least, he would like us to debate this—weakened the legitimacy of the international humanitarian protection system.
The new clause, tabled by the Father of the House, seeks to find a solution to the problem—one that he says will restore common sense. The first step of the new clause would put a duty on the Secretary of State through careful litigation before our courts to identify cases of individuals who could be deported under the refugee convention and torture convention but would be blocked under the ECHR. He sees cases such as KM, which I discussed, as exemplars of that. The new clause would disapply the duty on the Secretary of State to comply with the Human Rights Act in such cases. That is to ensure that the Secretary of State can proceed to deport such people, and if they want to challenge their deportation, their recourse will be to bring a case to Strasbourg.
I know that the Father of the House would be comfortable with putting a duty on Ministers to still deport such individuals even the face of a Strasbourg judgment or rule 39, but he knows that the firm commitment that the Government have to international law mean that they will refuse to do so—although he also said that we should ask why they would privilege the ECHR over the refugee convention. Instead, the new clause would allow the Government to comply with Strasbourg, while requiring them to argue with Strasbourg that it is wrong to interpret article 3 in a way that negates the provisions of articles 1F and 33(2) of the refugee convention.
Were Strasbourg to apply the principle of lex specialis properly, it should conclude that it cannot be unlawful for states to rely on articles 1F and 33(2) of the refugee convention in order to deport criminals. The Father of the House would be interested to hear from the Minister whether the Government would be interested in running such an argument before the Strasbourg court. Even were we to lose in such efforts to be reasonable, he feels that the new clause would allow the Government still to decide to comply with the flawed jurisprudence from the Strasbourg court; however, it would require that, were they to do so, they must be transparent with the British public and publish a report telling us who the criminals are whom we could have deported under the refugee convention, had the Strasbourg court’s flawed interpretation of the ECHR not prevented us from so doing.
I will not press the new clause to a vote, and I repeat that I did not table it, but I look forward to hearing what the Minister has to say.
Dame Angela Eagle
I compliment the Father of the House on his ingenious approach to the slightly different signals, as the hon. Lady set out, that the international conventions, with their judge-made law, have left us with over the years. The new clause would create a duty to remove people who are not protected by the refugee convention, irrespective of our obligations under the Human Rights Act and the European convention on human rights as it has developed. The hon. Lady set out that issue extremely well.
We will always seek to deport or remove foreign nationals who pose a threat to the UK or whose behaviour is such that they are not entitled to international protection. Where the UK’s obligations under the European convention on human rights prevent us from doing that, we will consider granting restricted leave, sending a clear message that the person is not welcome in the UK and will be removed as soon as possible. As the hon. Lady will remember, we amended the Bill to allow us to closely monitor people who pose a threat to the public but cannot be deported because of our obligations under domestic and international law. She will remember that that involves such things as curfews, and inclusion and exclusion zones.
The Government are clear: Britain will unequivocally remain a member of the ECHR, and work with international partners to uphold human rights and international law. Leaving would undermine protections for UK citizens and isolate Britain from its closest allies. The new clause would provide a mechanism to disregard a ruling of a court or tribunal that removal from the UK will breach a migrant’s human rights. That would place the UK in direct conflict with the European Court of Human Rights. The law does not permit us to operate with one foot in and one foot out; we are either in, as signatories to the ECHR, or we join Russia and Belarus as countries that do not accept its jurisdiction.
The law does not permit us to operate in that way; nor can it be said that the ECHR takes precedence over the refugee convention. They are distinct treaties of international law that deal with different issues. The new clause would therefore create a situation that would be wholly unworkable. I know that the Father of the House will look at this in due course. He has had a good go. We do not think that the proposal is workable. I therefore hope that it will not be pressed to a vote.
Dame Angela Eagle
It is at this occasion, traditionally, that those who have shouldered the burdens under your expert guidance of the Committee, Dr Murrison, thank all the officials—both the House officials and my own—for their sterling work.
I thank all members of the Committee for their contributions, all of which have come from positions of principle and concern. We have had some robust debates during our time in Committee; we have even had a bit of fashion commentary. I think we will all be pleased to get out of Committee today, because the room is getting colder as the week goes on—goodness knows where we would be if we had to come back on Thursday to finish our deliberations. I hope that members of the Committee have enjoyed scrutinising the Bill and having these debates as much as I have.
Bill, as amended, accordingly to be reported.
Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting)
Tuesday 18th March 2025
(2 days, 11 hours ago)
Public Bill CommitteesTerminally 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 18 March 2025 - (18 Mar 2025)
The Committee divided: - Ayes: 3 / Noes: 18 - Question accordingly negatived.
The Committee divided: - Ayes: 8 / Noes: 13 - Question accordingly negatived.
The Committee divided: - Ayes: 7 / Noes: 14 - Question accordingly negatived.
The Committee divided: - Ayes: 6 / Noes: 15 - Question accordingly negatived.
The Committee divided: - Ayes: 9 / Noes: 12 - Question accordingly negatived.
The Committee divided: - Ayes: 5 / Noes: 16 - Question accordingly negatived.
The Committee divided: - Ayes: 17 / Noes: 4 - Question accordingly agreed to.
The Committee divided: - Ayes: 6 / Noes: 16 - Question accordingly negatived.
The Committee divided: - Ayes: 7 / Noes: 15 - Question accordingly negatived.
The Committee divided: - Ayes: 7 / Noes: 15 - Question accordingly negatived.
The Committee divided: - Ayes: 7 / Noes: 15 - Question accordingly negatived.
The Chair
Good afternoon, ladies and gentlemen. Given the fluidity of matters on the Floor of the House today, my personal view, although it is only my view, is that I should not suspend the sitting at 5 o’clock. Hon. Members may leave the room at any time for a comfort break, but as there is likely to be an interruption and as the Committee may not want to sit too late, my view is that we should bash on, or rather that you should bash on. Mr Dowd will take the Chair at 5 o’clock, so I shall be able to escape. You have your own escape routes.
The Chair
Yes, there may be an escape committee.
Clause 18
Provision of assistance
Amendment proposed (this day): 462, in clause 18, page 12, line 20, at end insert—
“(3A) When providing a substance under subsection (3) the coordinating doctor must explain to the person that they do not have to go ahead and self administer the substance and they may still cancel their declaration.”—(Danny Kruger.)
The Chair
I remind the Committee that with this we are discussing the following:
Amendment 463, in clause 18, page 12, line 34, leave out paragraph (c).
Amendment 497, in clause 18, page 13, line 9, leave out “decides” and insert
“informs the coordinating doctor that they have decided”.
This amendment provides that the duty to remove the approved substance arises on the coordinating doctor being informed that the person has decided not to self-administer the substance.
Amendment 498, in clause 18, page 13, line 10, leave out
“that the substance is not”
and insert
“to believe that the substance will not be”.
This amendment clarifies the circumstances in which the coordinating doctor is under a duty to remove the approved substance from the person.
Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)
It is a pleasure to serve under your chairmanship, Sir Roger. My hon. Friend the Member for East Wiltshire was mid-intervention when the Committee adjourned this morning, and I would not want to pull the rug from underneath him. Does he wish to intervene again?
Danny Kruger (East Wiltshire) (Con)
I am grateful to my hon. Friend. I was simply asking what causes him to object to physician-administered assistance to die. If he supports the principle of assisted suicide and believes in doctor autonomy, why does he not think that doctors should be able to administer the fatal dose?
Dr Shastri-Hurst
This gets to the root of how the law has operated in another jurisdiction, Switzerland, where Dignitas has managed this scenario over the past 40 years or so. The key—these are the words that its own guidance uses—is ensuring that the power of control remains with the person seeking the assisted death. That provides the individual who is making the choice with the ultimate autonomy at the end in controlling the circumstances and the manner in which they pass.
I have set out why I feel that although amendment 463 arises from good intentions, it would not achieve what is intended. There is a real risk that the constraints that adopting the amendment would create would lead to the regrettable unintended consequence of individuals being forced to have an assisted death at an earlier stage than they would otherwise have wished.
I can deal with amendments 497 and 498 in short order. They would tighten up the Bill by providing greater clarity around the circumstances in which the substance would be removed from the presence of the individual who had previously indicated a wish to have an assisted death. Amendment 497 specifies that the individual would need to set out to the co-ordinating doctor that they no longer desired to go through with the process. In my view, that is eminently sensible. Amendment 498 elaborates on the Bill to provide greater clarity to those who will be operating it. It will make it a much more workable piece of legislation. I support both amendments.
The Minister for Care (Stephen Kinnock)
It is a pleasure to serve under your chairship, Sir Roger. Before I speak to amendments 497 and 498, on which the Government have worked with my hon. Friend the Member for Spen Valley, let me address amendments 462 and 463.
Amendment 462 would amend clause 18 to require the co-ordinating doctor to explain to the person that they do not have to proceed and self-administer the approved substance, and that they may still cancel their declaration. Although it is not specified, it is presumed that the amendment refers to the second declaration that the person will have made. The Committee may wish to note that there is already a requirement in clause 18(4)(b) that,
“at the time the approved substance is provided”,
the co-ordinating doctor must be satisfied that the person
“has a clear, settled and informed wish to end their own life”.
The purpose of amendment 463 is to limit what the co-ordinating doctor is permitted to do in relation to providing the person with an approved substance under clause 18. As the clause stands, subsection (6) sets out the activities that the co-ordinating doctor is permitted to carry out in respect of an approved substance provided to the person under subsection (2). It states that the co-ordinating doctor may
“(a) prepare that substance for self-administration by that person,
(b) prepare a medical device which will enable that person to self-administer the substance, and
(c) assist that person to ingest or otherwise self-administer the substance.”
Additionally, subsection (7) provides that
“the decision to self-administer the approved substance and the final act of doing so must be taken by the person to whom the substance has been provided.”
Amendment 463 would remove subsection (6)(c), which would result in the co-ordinating doctor being unable to assist the person
“to ingest or otherwise self-administer”
the approved substance. The co-ordinating doctor would still be permitted to prepare that substance for self-administration and to prepare a medical device to enable the person to self-administer the substance. This could mean that a co-ordinating doctor may not be able to provide assistance such as helping the person to sit up to help with swallowing, or explaining how the medical device for self-administering the substance works. This could result in practical difficulties in self-administration of the substance and/or place the co-ordinating doctor in a difficult position.
Sojan Joseph (Ashford) (Lab)
Does the Minister think that it is confusing for health professionals when we say that they can assist the patient to sit up or hold a cup of water or put the medication into their mouth? Is it not confusing for medical professionals that we are giving contradictory statements?
Stephen Kinnock
One of the fundamental principles of the Bill, which my hon. Friend the Member for Spen Valley has prioritised, is self-administration. It is not for me as a Minister to opine on that; it is simply there in the Bill. Once that fundamental principle is established, it is about defining what “assistance” means, compared with what “self-administration” means. As I was setting out, I think “assistance” can mean things like helping the patient to sit up; it does not mean actually administering the substance to the patient. It is about the dividing line between assistance and self-administration—hence the term “assisted dying”, I suppose, which is very different from the doctor actually administering the substance.
Rebecca Paul (Reigate) (Con)
I am going to read subsection (6)(c) again. It says:
“assist that person to ingest or otherwise self-administer the substance.”
I would interpret that slightly differently from the Minister. It talks about ingesting, which suggests the substance entering the body, so I would not suggest that sitting someone up would qualify. That in itself shows that perhaps there is some ambiguity here. The Minister has set out something that I had not read into the Bill. Will he comment further on that?
Stephen Kinnock
I will pretty much repeat what I have just said to my hon. Friend the Member for Ashford. There is a dividing line, as the Government see it, between assistance and administration. There is a dividing line between making the patient comfortable, enabling the procedure to take place, and the doctor actually putting the substance into the body of the patient. From the Government’s point of view, simply from the position of having a picture of the process in our mind, that dividing line is clear enough in the drafting of the clause.
Danny Kruger
I am grateful that the Minister is allowing us to push him on this, because it is crucial. This is the moment beyond which there is no return. He thinks that helping a patient to sit up would be within the scope of the clause. Does he think that holding the patient’s hand and tipping a cup of pills into their mouth would be consistent with the clause?
Stephen Kinnock
My interpretation is that it would not be, because if someone were actually tipping the pills into the mouth of the patient, they would be going through the act of putting the substance into the patient. This Bill is founded on the principle of self-administration. However, there are acts such as helping the patient to sit up that are not direct administration but assistance enabling it to take place. That is where the distinction lies.
Danny Kruger
That is helpful, but if the patient were holding the cup and the doctor held their hand to help them tip it into their mouth, it is not clear to me at what point assistance would end and self-administration would begin. I would be grateful if the Minister could explain that. What about the scenario in which the patient’s finger is on the plunger of a syringe and the doctor assists by putting their finger on top of the patient’s and assists them to press the button, adding a little force to that being given by the patient? Does he regard that as within the scope of self-administration, or does that cross the line into directly administering the procedure?
Stephen Kinnock
I thank the hon. Member for that intervention. The hon. Member for Solihull West and Shirley pointed out earlier that the scenario that he has just described would constitute more than assistance; it would be moving into administration by the doctor, rather than self-administration. I think that that aligns with the Government’s view, so I refer the hon. Member for East Wiltshire to those comments from the hon. Member for Solihull West and Shirley, who has far more clinical experience than I do.
Danny Kruger
I am grateful for that, and I will leave it there, but does the Minister agree that it is incredibly difficult to distinguish who is administering the treatment in that scenario? If both their hands are on the instrument, whatever it is—a cup, a syringe or a button on a computer screen—it is very hard to know who has actually delivered the final act.
Stephen Kinnock
What is hard to do in this Committee is imagine and agree on how many different scenarios there can be. Every circumstance and every individual experience will be different, so it is difficult for us to envision all the different scenarios. Nothing about this is easy, of course. We would not have been sitting in this Bill Committee for hours on end if it were all easy, but from the Government’s point of view there is a clear enough distinction between assistance and self-administration. As long as we are clear on those basic principles, we feel that that gives enough safety to the Bill and enough clarity around the process.
Kit Malthouse (North West Hampshire) (Con)
Does the Minister agree that my hon. Friend the Member for East Wiltshire is perhaps unintentionally creating a lack of clarity where there is clarity? Surely there is complete clarity in the distinction between assisting a patient to be in a position to carry out their final desire and act, and performing or even jointly performing that final act with them. Is it not the case that in overseas jurisdictions there is quite a lot of assistance with technology? It needs to be prepared and put in place, but it can put even those who are the least physically able in a position in which the final act of administration can be clearly theirs. In many ways, our life is made easier by modern technology in that regard.
Stephen Kinnock
The right hon. Member sets out clearly the difference between self-administration—the concept at the heart of the Bill—and the performance of the act either jointly or by the doctor. The latter is not permitted under the terms of the Bill; the former is. That is where we are.
Dr Simon Opher (Stroud) (Lab)
The lack of an ability to assist in the final process would put medical professionals in a very difficult position. Would carrying the medicine to the room where the patient is count as assistance? I think we have to have assistance in the Bill, but I also feel that, as the Minister has outlined clearly, someone can help a person to self-administer but cannot administer. That is quite clear to me.
Stephen Kinnock
I thank my hon. Friend, who speaks with considerable clinical expertise. It is about exactly that difference between self-administration and administration. If we cleave to those two principles, that is the basis on which we will achieve the stated aim of my hon. Friend the Member for Spen Valley.
Sojan Joseph
Does the Minister agree that assisting a person to ingest is different from assisting a person to self-administer?
Stephen Kinnock
In order to ingest, there has to be self-administration. The self-administration is the precondition for ingesting the substance. That is my reading. I hope that that satisfies my hon. Friend.
Rebecca Paul
The Minister is being incredibly patient with our questions. The question from the hon. Member for Ashford raises exactly the point with which I am uncomfortable. To me, the phrase
“assist that person to ingest”
means something else. I am really concerned that it could be interpreted differently from how the Minister has laid it out. I want to place that on the record and raise that issue, which I believe the hon. Member was also raising.
Stephen Kinnock
The hon. Member’s concerns are absolutely noted. I completely understand that hon. Members are not comfortable with this, but what I am trying to do is set out the Government’s view on the workability of what my hon. Friend the Member for Spen Valley is seeking to achieve and the basic principles on which that is built.
Amendment 497, on which the Government have worked jointly with my hon. Friend, would amend clause 18(11), which states:
“Where the person decides not to self-administer the approved substance, or there is any other reason that the substance is not used, the coordinating doctor must remove it immediately from that person.”
Under the clause as it is currently drafted, there could be difficulties in relation to the duties of the co-ordinating doctor where the co-ordinating doctor does not know what the person has decided. Amendment 497 seeks to resolve that ambiguity by clarifying that the duty on the co-ordinating doctor to remove the approved substance applies where the person
“informs the coordinating doctor that they have decided”
not to self-administer the approved substance.
I turn to amendment 498. At present, clause 18(11) provides that the co-ordinating doctor has the duty to immediately remove the approved substance where the person decides not to self-administer the approved substance, or there is any other reason that the substance is not used. The amendment clarifies that the duty to remove the substance arises when the co-ordinating doctor believes that the substance will not be used. I hope that those observations have been helpful to the Committee.
Kim Leadbeater (Spen Valley) (Lab)
The Minister has covered my amendments 497 and 498 very clearly, so I will not speak to them.
I am happy to support amendment 462, tabled by the hon. Member for East Wiltshire, about which we had a conversation this morning. I only make the observation that there is already a requirement in clause 18(4)(b) that, at the time the approved substance is provided, the co-ordinating doctor must be satisfied that the person has
“a clear, settled and informed wish to end their own life”.
Nevertheless, I am happy to support the amendment, because the hon. Member made a very valuable point this morning.
I cannot support amendment 463, however. The Bill states that the patient must self-administer the drugs. Clause 18(7) states that “the final act” of self-administering the substance
“must be taken by the person to whom the substance has been provided.”
That is very clear. The hon. Member for Solihull West and Shirley, with his medical background and expertise, has been clear and helpful on this point: it is a question of passive versus active. We have to be clear that the patient must have an active role in self-administration.
Danny Kruger
I propose to press both my amendments to a vote if necessary.
Amendment 462 agreed to.
Amendment made: 496, in clause 18, page 12, line 28, after “professionals” insert “, and such other persons,”.—(Kim Leadbeater.)
This amendment provides that the coordinating doctor may be accompanied by such persons (other than health professionals) as the doctor considers necessary.
Danny Kruger
On a point of order, Sir Roger. I am sorry if I missed it, but are we not going to debate amendment 496?
The Chair
I put the Question and nobody spoke. I am afraid the moment has passed. Under this Chairman, you have to be fleet of foot.
Danny Kruger
Clearly! Fair enough.
Amendment proposed: 463, in clause 18, page 12, line 34, leave out paragraph (c)—(Danny Kruger.)
Question put, That the amendment be made.
Tom Gordon (Harrogate and Knaresborough) (LD)
I beg to move amendment 350, in clause 18, page 12, line 34, at end insert—
“(d) subject to subsection (6A), provide additional assistance to administer the substance in the presence of an independent witness.
(6A) The coordinating doctor may provide the additional assistance under subsection (6)(d) when—
(a) the coordinating doctor is satisfied that the person is permanently and irreversibly unable to self-administer the substance due to—
(i) significant risk of choking as a result of dysphagia, or
(ii) the loss of use of the limbs; and
(b) the person has authorised that the additional assistance be provided.”
This amendment would define the eligibility criteria for those who are permanently and irreversibly unable to self-administer the substance and are therefore eligible for additional assistance to administer the substance.
The Chair
With this it will be convenient to discuss the following:
Amendment 351, in clause 18, page 12, line 35, after “substance” insert
“or to authorise additional assistance to be provided”.
This amendment would ensure the decision to administer the approved substance remains with the person but would allow those who are unable to self-administer the substance to receive further assistance.
Amendment 352, in clause 18, page 12, line 40, at end insert
“, unless the criteria in subsection (6A) are met.”
This amendment would authorise the coordinating doctor to provide additional support with administration for those who are unable to self-administer the substance.
Tom Gordon
It is an honour to serve under your chairmanship, Sir Roger. I speak in support of this group of amendments, which address the issue of fairness and accessibility in the Bill. The amendments seek to ensure that those who are physically unable to self-administer the approved substance due to their condition are not excluded from the choice of an assisted death.
The principle at stake here is equity: making sure that this opportunity would be available to not only those with the physical ability to self-administer but all eligible individuals, regardless of their condition. The Motor Neurone Disease Association made it clear in its written evidence that conditions like motor neurone disease can be cruel, devastating and progressive, locking people inside their own failing bodies. More than 80% of people with MND lose the ability to speak. Many lose all limb function, leaving them unable to lift even a glass of water, let alone self-administer medication.
There is a common theme here that relates to a point I made in an earlier sitting, when we debated the period of time for eligibility. For these individuals, the Bill in its current form creates a barrier. It states that the final act of ingesting or administering an approved substance must be taken by the person themselves. For someone with advanced MND, that may simply not physically be possible. The MND Association’s evidence highlights that in other jurisdictions, such as Queensland in Australia, allowances have been made for people unable to swallow or self-administer. If we fail to include such provision here, we risk excluding some of the most vulnerable people or, even worse, creating a perverse incentive for them to seek an assisted death earlier, possibly abroad, when they may still have physical function.
These amendments are not about lowering safeguards in any way, shape or form. As we know, the Bill has robust safeguards, which these amendments would maintain. It would only be applicable in instances where doctors deem it necessary, and it would not be open to more than those with conditions restricting their ability to self-administer. If the Bill is about compassion, then we must ensure that that compassion extends to everyone; if it is about choice, then we should not deny that choice to those with severe physical limitations; and if it is about justice, then we should not allow injustice to be written into the law.
Naz Shah (Bradford West) (Lab)
I rise to oppose amendments 350 to 352, tabled by my hon. Friend the Member for Gedling (Michael Payne). They would allow the co-ordinating doctor to provide additional assistance to administer the substance in the presence of an independent witness, in some circumstances. Those circumstances would be when, as amendment 350 says, the doctor determines that the person is
“permanently and irreversibly unable to self-administer”
the lethal substance because of an inability to swallow or the loss of use of the limbs. The amendments do not spell out what the additional assistance would be, but I think it is reasonable to believe that it refers to the doctor injecting the lethal substance into a person’s circulatory system.
My hon. Friend’s amendments comes from genuine concern about the situation that some people may well find themselves in. Some people who might otherwise qualify for assisted dying under the Bill might be unable to swallow or inject the lethal drugs. We should all respect the feeling that lies behind the amendments, but we should reject them. If we pass them, we will have accepted that doctors can help people who have qualified for assisted dying to prepare to inject themselves with lethal drugs or swallow them. The Bill does not say that doctors can do that. I do not know whether the House would have voted for the Bill on Second Reading if it had, but that is beside the point—it was not part of the Bill. If we were ever to consider taking such a radical step, we should only do so after hearing as much evidence as possible on why and how this might be necessary. I urge the Committee to oppose the amendment.
Danny Kruger
It is a pleasure to follow the hon. Lady; I very much agree with her points. I also pay tribute to the hon. Member for Harrogate and Knaresborough, who spoke with his now customary intellectual clarity and moral constituency. He believes in autonomy, and he is doing what he can to resolve the essential contradiction in the Bill, which is designed to enable people to end their lives at their own discretion. He recognises that some of the safeguards in the Bill, which of course I do support, nevertheless represent barriers to what we are now suggesting is a human right, and that that human right will be restricted to a limited number of people, according to the Bill.
It is my view that the pressure, momentum or inherent direction of travel that the Bill sets us on will necessarily result in these sorts of amendments to the legislation in due course, whether in the form of subsequent amendments passed through legislation, the guidance that is issued, or indeed the practice of doctors. As I tried to explain in my comments on the previous group, my concern is that the Bill allows for quite a wide degree of discretion, naturally and necessarily enough, in the form of doctors interpreting their ability to assist in ways that respect the autonomy of patients, but are, in fact, a step beyond what the Bill—quite rightly, in my view—seeks to allow.
Tom Gordon
The hon. Member mentioned that down the line the Bill could be changed through guidance. I do not think there would be any scope or ability to do that. Does he agree that that point might be a little bit beyond what we all think might be possible under the terms of guidance?
Danny Kruger
I hope the hon. Gentleman is right. Nevertheless, one of my concerns about the Bill is that we are leaving enormous areas of clinical practice, and regulated conduct for the professionals involved in assisted suicide, to be performed under guidance that is still to be set out and that it is the job of future Ministers to determine.
I pay tribute to the hon. Gentleman, because he has correctly identified a group of patients for whom the drafted Bill may present obstacles to the fulfilment of their wish for an assisted death. My belief is that the ability to assist will probably cover almost anybody who wants it and has found a doctor who wants to help them, but the hon. Gentleman is right that there are some groups for whom that might be more of a challenge than others. I think the answer we are going to get—it is one made by hon. Members in the debate already—is that technology will fix it, and I fear it will, because I think we are going to find ourselves in a world in which it is perfectly possible for the administration of death to be enabled through some kind of technological device, which somebody with the most limited physical mobility will nevertheless be able to activate.
I fear the insistence that we have on self-administration. Although we can all acknowledge, as referenced in the previous debate, the conceptual difference between administration and self-administration, we do have this idea that we are individuals cut off from each other and that there is an essential gap between us and other people. At the very end of life, though—in the moments that we are considering and legislating for—that distinction is void, because we are intimately connected with other people, as per the clauses that we are debating. I fear that we are going to find ourselves in a world in which a laptop will be set up and even a movement as small as the blink of an eyelid by the patient will be enough to trigger what will be called “self-administration” of the fatal dose.
I oppose this group of amendments, moved by the hon. Member for Harrogate and Knaresborough, because I do not believe in assisted suicide. I do not understand why other supporters of the Bill are not following the hon. Gentleman’s lead, and acknowledging that if we believe in autonomy and assisted suicide, of course we should enable patients to have the final act performed upon them, rather than insisting on this arbitrary distinction that it is possible to insist on self-administration in all cases.
Rebecca Paul
It is clear that the hon. Member for Harrogate and Knaresborough is trying to create equity, which we all understand. We need to think about the patient on the one hand, but also the doctors, nurses and medical practitioners involved. Does my hon. Friend agree that we need to think about the obligation and impact of such amendments on them?
Danny Kruger
Yes. We discussed this briefly this morning. There is an important consideration about the effect on medical staff involved in the administration of assisted suicide, and we have to make sure that those who do not want to participate are properly insulated from any sort of obligation, which I know is the intention of the Bill’s promoter, the hon. Member for Spen Valley. Nevertheless, I am concerned about the knock-on effect of participation in assisted suicide spreading across a practice. I agree with my hon. Friend that we have to be mindful of the impact on doctors. The more we widen the scope—as logic compels us to do, as the hon. Member for Harrogate and Knaresborough suggests—the more it is about not just discretion, but an obligation on doctors to approve.
We need to think about the conversation that doctors will be required to have with patients who are expressing that wish. If the Bill is widely drawn, as it would be if we were to accept these amendments, there is more opportunity for a doctor to feel compelled to assent to a request.
Sean Woodcock
The hon. Member for Harrogate and Knaresborough is clearly trying to right what he believes to be an inherent injustice in the Bill, but is the hon. Member for East Wiltshire concerned, as I am, that if the amendment were to pass, it would take the debate from a place of being about assisted dying towards what many people would term euthanasia? That is not something that the House in any way endorsed by voting for the Bill on Second Reading.
Danny Kruger
I am absolutely certain that if the amendment had been in the original Bill, the Bill would not have passed Second Reading, because it would have validated the argument that many of us made that the implication of assisted suicide is euthanasia. The distinction between them, while valid in the abstract, does not apply in practice, and that distinction will be quickly overridden in time. I agree with the hon. Gentleman.
Dr Shastri-Hurst
Although I have certain sympathies with these amendments, I do not feel that they are necessary or desirable. They are not necessary because of the provisions that are already stipulated in clause 18(6)(b), which provides the co-ordinating doctor with the ability to prepare
“a medical device which will enable that person to self-administer the substance”.
That subsection, in effect, negates the scenario that is put forward in amendment 350 around dysphagia or the loss of a limb. It would permit, for example, the use of a nasogastric tube or a percutaneous endoscopic gastrostomy feeding tube to be used for the administration of the substance in the case of dysphagia. In the case of the functional loss of limbs, as was discussed in the debate on the previous group, a range of assisted technologies are available that would remove the barriers that that would present.
Beyond the necessity, or lack of necessity, of these amendments, I fear that they create legal uncertainty, which is clearly undesirable and, in this instance, could have a serious and significant unintended consequence through the amendments’ interaction with clause 24. Subsection (3) of that clause inserts proposed new section 2AA of the Suicide Act 1961, which is an exemption to that Act in respect of the assistance provided under this Bill. In effect, proposed new section 2AA disapplies sections 2(1) and 2A(1) of the Suicide Act where the provision of assistance is done in accordance with the Bill. Those sections specifically relate to an act
“capable of encouraging or assisting the suicide or attempted suicide of another person”.
Introducing the concept of additional assistance, as these amendments would, creates a legal uncertainty. The word “additional” creates a further concept that is beyond assistance but is, thus far, ill defined. Would it go as far as, for example, the clinician taking full control of administering the substance? It is entirely unclear. It would therefore place the clinician in an invidious position as to what it would mean for them to provide additional assistance in such circumstances. As I read the interplay between the Suicide Act and the proposed legislation, the clinician would not then be exempt by virtue of clause 24(3), leaving them open to prosecution under the Act.
Danny Kruger
I am grateful for that; I particularly respect my hon. Friend’s concern to protect the doctors from any confusion in the law they might be operating under. Just to take him back to the question of technology resolving what I regard as an insuperable problem—the difference between assistance and administration—is it my understanding that my hon. Friend would oppose a patient’s being able to ask a doctor to administer a lethal drug to him or her, but that he would support a patient’s being able to ask a computer to administer a lethal drug to him or her? Would he accept the computer performing the act at the patient’s request?
Dr Shastri-Hurst
My hon. Friend hits the nail on the head, because it is the patient who is driving the decision. They are making that act by activating the electronic device—the computer or whatever it may be in terms of assistive technology—but they have the power and control over that decision-making process, which is completely distinct from a clinician doing that act. It is distinct because it is activated by the patient—by the person making that decision—and that is why I draw the distinction. My hon. Friend may not agree, but that is my rationale for drawing a distinction between the two.
Dr Opher
I agree with all the hon. Gentleman’s points. In terms of assistance, what we are talking about, potentially, if the technology arrives at that, is that the doctor may be able to put a Venflon into the patient’s vein, but they would not put the drug through the Venflon into the vein. That would enable the patient to have control. That is the type of assistance that could be quite useful in this scenario, but it would not involve the doctor actually delivering the drug.
Dr Shastri-Hurst
I am grateful for that helpful and thoughtful intervention.
For the reasons I have set out, I consider that the amendments create unnecessary and highly undesirable legal confusion, so I shall not support them.
Stephen Kinnock
Currently, clause 18(6) permits the co-ordinating doctor, in respect of an approved substance provided to the person under subsection (2), to undertake the following activities: prepare the approved substance for self-administration; prepare a medical device to enable self-administration of the approved substance; and assist the person to ingest or otherwise self-administer the substance. Furthermore, subsection (8) expressly provides that subsection (6)
“does not authorise the coordinating doctor to administer an approved substance to another person with the intention of causing that person’s death.”
Amendment 350 seeks to enable the co-ordinating doctor, in the presence of an independent witness, to provide “additional assistance” to the person to administer the approved substance. Such assistance can be provided only where the person has authorised it, and where the person is
“permanently and irreversibly unable to self-administer the substance”
due to a significant risk of choking due to difficulty swallowing—dysphagia—or loss of the use of their limbs. The term “additional assistance” is not defined in these amendments.
Amendment 351 is consequential to amendment 350 and would require any decision to authorise additional assistance for the self-administration of the substance to be made by the person to whom the substance has been provided. Amendment 352 would create an exception to the condition in clause 18(8), and would have the effect of permitting the co-ordinating doctor to administer an approved substance to another person with the intention of causing that person’s death where the criteria introduced in amendment 350 are met—that is, where the co-ordinating doctor is satisfied that the person is permanently and irreversibly unable to self-administer the substance, and that the person has authorised that the additional assistance be provided.
Our assessment is that the amendments would enable the co-ordinating doctor to administer the approved substance to the person, rather than merely assisting the person, in the limited circumstances provided for in clause 18(6), to self-administer. That would be a significant change to one of the fundamental principles of the promoter’s Bill—that the final act of administering the approved substance must be taken by the person themselves, and not by a co-ordinating doctor. That is a policy matter and a decision for the Committee.
However, should the amendments be accepted, further amendments may be needed to ensure that this provision is fully legally coherent and workable in several areas. First, amendment 350 does not define who qualifies as an independent witness—for example, whether this would have to be a health professional or whether it could be a family member. Secondly, it does not address whether anyone would be disqualified from being an independent witness, as provided for through clause 36, which is entitled “Disqualification from being witness or proxy”.
Finally, as drafted, amendment 350 does not detail how authorisation of the additional assistance must be obtained and/or recorded in order to be valid. It also does not require that any details about the independent witness be recorded. This could lead to difficulties in complying with and/or evidencing that the requirements to provide the additional assistance have been met. By extension, there will be a lack of clarity over when and how the criminal provisions are to apply. I hope that those observations were helpful.
Kim Leadbeater
I completely understand where these amendments are coming from. In many jurisdictions where assisted dying laws are in place, this would be an accepted part of the process. However, as I have said repeatedly, our Bill stands in its own right, and its safeguards are stronger than those anywhere else in the world. One of those safeguards is that the line cannot be crossed between a person shortening their own death by administering the drugs themselves and by having another person—in this case the doctor—do it for them.
While I am hugely sympathetic to the argument, that is a line that I do not believe the Bill should cross. I concur with the comments of my hon. Friend the Member for Bradford West about Second Reading and what the House voted for, and with those of the hon. Member for Reigate about medical profession levels, which we discussed this morning. I also agree with the Minister’s comments about the concept of an independent witness, and with the comments from the hon. Member for Solihull West and Shirley about the concept of additional assistance. On that basis, I will not be supporting the amendments.
Tom Gordon
I will keep it short and sweet. I had not intended to push the amendments to a vote and will not be doing so. A lot of important points have been raised. Irrespective of whether the amendments were going to be pushed to a vote or would have been successful, it is important that we listen to and take into account the voices of people with different diseases who might wish to access an assisted death. We must also take into account the evidence that organisations have submitted, because it is important that those voices are heard too. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Danny Kruger
I beg to move amendment 435, in clause 18, page 13, line 6, at end insert—
“(9A) Where the procedure has failed, the coordinating doctor must escalate the care of the person by making the appropriate referral to emergency medical services.”
This amendment would require the doctor to escalate the care of the person in cases in which the procedure fails.
The Chair
With this it will be convenient to discuss the following:
Amendment 429, in clause 18, page 13, line 7, leave out subsection (10).
Amendment 436, in clause 18, page 13, line 8, after “provided” insert—
“(10A) If complications occur as a result of the provision of assistance the coordinating doctor must—
(a) make a detailed record of the complications in the patient’s medical records,
(b) make a declaration on the final statement issued under section 21, and
(c) make a report to the relevant Chief Medical Officer and the Voluntary Assisted Dying Commissioner.”
This amendment would require the coordinating doctor to record any complications in the patient’s medical records, to make a declaration on the final statement issued under section 21, and make a report to the relevant Chief Medical Officer and the Voluntary Assisted Dying Commissioner.
Amendment 464, in clause 18, page 13, line 8, at end insert—
“(10A) If the person loses consciousness and it appears to the coordinating doctor that the procedure is failing, the coordinating doctor—
(a) must not do anything with the intention of causing the person’s death, and
(b) must seek to revive the person.”
Amendment 532, in clause 18, page 13, line 12, at end insert—
“(12) The Secretary of State must by regulations make provision about what the coordinating doctor is legally permitted to do if it is determined by the coordinating doctor that the procedure has failed.
(13) The regulations under subsection (12) must include what specific actions can legally be taken by the coordinating doctor if—
(a) there is a greatly prolonged time to death,
(b) the person has been rendered unconscious, or rendered unfit to make a second attempt at self-administration, but has not died, or
(c) the person is otherwise undergoing complications.”
Amendment 533, in clause 18, page 13, line 12, at end insert—
“(12) For the purposes of subsections (2) to (11), the Secretary of State must, by regulations, specify where the provision of assistance under this Act may take place.
(13) Before making regulations under subsection (12), the Secretary of State must consult such persons as the Secretary of State considers appropriate.
(14) The persons to be consulted under subsection (12A) may include—
(a) persons requesting or considering requesting assistance to end their own lives, and
(b) professionals working in palliative and end-of-life care, including hospice staff, and
(c) persons from disadvantaged and marginalised communities, and
(d) registered medical professionals and other healthcare professionals.”
Amendment 430, in clause 30, page 18, line 30, at end insert—
“(da) responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails;”
Amendment 255, in schedule 6, page 32, line 13, at end insert—
This would add the means of administration to the final statement set out in Schedule 6.
Danny Kruger
I am supportive of all the amendments in this grouping, including amendment 255 in the name of the hon. Member for Filton and Bradley Stoke (Claire Hazelgrove) about the importance of recording the means of administration of the substance. We have discussed that a bit, and I think it is important to include it. The amendments tabled by the hon. Member for Bexleyheath and Crayford are also important, as they insist on the actual physical presence of a doctor while the treatment is being carried out. His amendments also suggest that there should be a code of practice about what should happen when things go wrong; I want to go further than that, but I do approve of that measure.
On amendments 532 and 533, tabled by the hon. Member for Ipswich, I again support in principle the requirement—although there is a little too much regulation by the Secretary of State, in my view—that we be clear about where the act should take place and make provision about what the co-ordinating doctor is legally permitted to do if they determine that the procedure has failed. That is the point I really want to discuss; the amendments tabled by the hon. Member for York Central (Rachael Maskell), and the amendment that I tabled, would impose an obligation on the co-ordinating doctor to provide assistance if the procedure fails.
Let me take a moment to explain to the Committee how important it is that we recognise the genuine risk of that eventuality in the case of assisted suicide being performed. There is significant evidence—even given the lack of adequate data collection and the paucity of record keeping, with over half of assisted deaths not properly recorded at all in many places—that in places such as Oregon, which is one of the worst offenders when it comes to data collection, there are significant rates of complication. These can be difficulty with ingesting the drugs, regurgitation and seizures. As I said, 72% of deaths do not record whether complications have occurred, but among the quarter that do, there are significant rates of complication.
Sometimes death can take days, and there can be a long time of unconsciousness. The Committee has heard from me and others in previous debates about the extent to which there is real concern about the actual experience of the administration of assisted death. But it is striking how ill-defined the current Bill is on the point about complications, compared to jurisdictions where such laws are in operation. In other countries, there is clear guidance in law for what should be done. In the Netherlands, euthanasia is recommended when assisted suicide seems to be failing; in Canada, doctors are likewise given licence to administer the death themselves if it fails. The Committee has decided not to proceed down that road. Nevertheless, the question arises as to what on earth patients should do.
To the point that we are talking about a small or non-existent population group—those we might have to worry will experience complications after the administration of fatal drugs—I refer back to a previous debate, when the hon. Member for Stroud, referring to me, said:
“The hon. Gentleman is bringing up lots of rather horrible stories about assisted death. That is why, in Australia, Switzerland and Holland, they have decided, instead of using the regime that he is talking about, to use pentobarbital…One of the reasons why Dignitas uses it is that it is so effective and it does not have those effects.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 11 March 2025; c. 925.]
Having looked into the issue and consulted other medics, I am afraid that the fact is that the safety of pentobarbital is highly contested. It has been debated in litigation in the United States because of its use as a death penalty drug. The executioners who used it said that the deaths were peaceful and akin to falling asleep, but lawyers for inmates on death row have said that
“pentobarbital caused flash pulmonary edema, in which fluid rushes through quickly disintegrating membranes into lungs and airways, causing pain akin to being suffocated or drowned.”
That is evidence from professionals who have examined the effect of pentobarbital on deceased people.
The anesthesiologist Joel Zivot of Emory University hospital in the United States testified to the Canadian Senate on the subject of assisted suicide drugs. He said that when he researched the autopsies of those executed by lethal injection, he stumbled on an alarming discovery:
“When I looked at the autopsies, to my surprise, I found that, in most of the cases, the individuals who had been executed by pentobarbital had fluid congested in their lungs. The lungs of these individuals were twice the normal weight, full of water. Now, the only way that this could have happened would have been as a direct consequence of the pentobarbital that was injected into these individuals.”
What is the relevance of that for assisted dying?
Kim Leadbeater
I am not aware of the situation in America, but is the hon. Gentleman not reassured that the evidence from Dignitas, which we all now have access to, says that there have been
“no cases of failure at Dignitas using this medication”?
Danny Kruger
Let me come on to that, because I am not aware of any evidence from Dignitas that disputes the assertion that is being made—certainly none that would meet the concerns raised by the genuine evidence of the effect of pentobarbital on death row patients. Again, the absence of evidence is not evidence of absence. I do not think that Dignitas has supplied evidence to contradict the point that I am making.
Kim Leadbeater
For the hon. Gentleman’s reference, I believe that the evidence is TIAB 425.
Danny Kruger
I am grateful to the hon. Lady. Let me let me look that up later. I am happy to exchange data, because this is clearly something we should be trying to get right.
Nevertheless, I want to try to explain why I am suggesting that we have a problem with the drugs that are used in assisted dying and that it has been suggested we use here. Let me continue the quote from Dr Zivot:
“When one watches an execution, it’s not clear that this is happening”—
meaning that it looks like a peaceful, painless death. He continues:
“There is not much to see. Executions, like, I imagine, medical assistance in dying, are a rather bloodless event; not much can be seen outwardly. But the autopsies revealed a very disturbing and surprising finding.”
He makes the point that that is particularly disturbing, given that assisted dying often uses a paralysing drug, which induces the impression of peace and calm in the patient, when in fact something else might be going on below the surface.
To conclude my quote from Dr Zivot, he says:
“To claim that this is a death that is peaceful, well, it can be nothing else because now a person is unable to move in any way, but whether or not they have any conscious experience of what is happening is unknown…it should be clear to the Canadian public that the kind of death that they will experience…will be something other than the way it is represented. It could be exceedingly painful and more akin to drowning.”
I cannot judge whether Dr Zivot is right, but we should be very wary of any claims that there is a simple answer to the question surrounding lethal drugs. To the point made by the hon. Lady, and I think by the hon. Member for Stroud, there is no evidence in the many reports from Dignitas, which has a regime very similar to the one we are imagining here—I will certainly look at the evidence mentioned made by the hon. Lady—that contradicts the concerns raised by Dr Zivot.
Sojan Joseph
Does this not show that clinical documentation is very important? We debated the issue in Committee earlier, when we talked about professionals being required to complete all relevant documentation. Maybe we are missing certain data because these things are not clearly documented in other places. Should we not take from that the learning that if we go ahead with this proposal, we should have proper documentation and make it clear to the clinician what they should and should not document?
Danny Kruger
I entirely agree that there is great concern about the lack of evidence in countries on which we are constantly relying for evidence of why this proposal is safe. I have suggested that, from the quite limited evidence we have, that it may not be safe. The hon. Gentleman is absolutely right that if we are to proceed, we need to be extremely strict about data collection.
To the hon. Gentleman’s point about making it clear to clinicians what drugs they are permitted to use, we also need to have a proper regime of clearing and approving those drugs. In earlier clauses, we debated the imperative on the NHS, the Medicines and Healthcare products Regulatory Agency and the Department of Health to properly authorise the specifics of what drugs will be used. It is not clear at the moment what those would be, and I very much agree that we need to be clearer on that.
I finish with a reference to an earlier debate, in which it was suggested, on the basis of the Australian example, that there is no evidence of complications. The hon. Member for Stroud talked about horrible stories from the United States and Canada. He also referred to Australia, where there is apparently no evidence of problems. In fact, I understand that of the six states, only Western Australia records complications, and it does so in relation only to practitioner administration—when the doctor administers the drug—which we do not propose to do here. It does not record complications in relation to self-administration, which is what the Bill proposes. In Western Australia, complications have been reported in 4.3% of cases involving practitioner administration. Again, we are dealing with the great mystery and enigma of how death happens with assisted suicide, and it is certainly unclear what we should do about it.
Naz Shah
Following the intervention of my hon. Friend the Member for Spen Valley, I have just looked at some of the evidence, and it does not cite any papers. In effect, the evidence says the effect can be seen in three documentaries. Nor does it explain why Dr Zivot’s concerns are scientifically accurate. Does the hon. Gentleman want to speak to that?
Danny Kruger
There is great anxiety about the validity of much of the evidence in this space. I have great respect for the work of Dr Zivot, because nothing else gets us close to understanding the actual effect of these drugs, once somebody has died.
Kim Leadbeater
In response to the intervention of my hon. Friend the Member for Bradford West, the evidence from Dignitas is really clear: there have been no cases of failure when using this medication.
Danny Kruger
My strong suspicion is that this is because the evidence is not being accurately collected or reported. With Dignitas and in all these jurisdictions, as the hon. Lady has acknowledged, there are significant failures of data and record keeping. Obviously, it is very much in Dignitas’s interest not to collect and certainly not to publicise evidence of things going wrong. However, that clearly happens in jurisdictions where data is properly collected.
Naz Shah
I recognise that the written evidence, particularly TIAB 425, says there have not been any failures at Dignitas, but it does not cite any published, let alone peer-reviewed, research, nor does it challenge the analysis of scientists such as Dr Zivot. That remains a grey area.
Dr Opher
Actually, if we did an autopsy on any person who has died, pulmonary oedema would almost certainly be found because that is what happens in death—the heart stops and the lungs fill with fluid. I would also like to correct the idea that there is neuromuscular paralysis with pentobarbital. There is no way that barbiturates act in that way. All they do is sedate and put the person to sleep, and death comes afterwards.
Danny Kruger
I was not suggesting that pentobarbital has a paralytic effect. Often in assisted dying, a paralytic is administered first as part of the cocktail of drugs. Subsequently, we discover that while the patient may have appeared entirely calm, sleeping peacefully, significant trauma may have been occurring beneath the surface.
I defer to the hon. Member’s knowledge, but my understanding from the scientific evidence I have read, and that medics have given to me, is that the extent to which people executed by lethal injection, by pentobarbital, have their lungs fill with fluid is peculiar—it is remarkable. They effectively drown beneath their peaceful exterior.
I intend to press amendment 464 to a vote, and I intend to support other amendments in this group. Although I support the aspiration of amendment 532 to make provision for what to do in the event of a procedure’s failure, I think it gives too much leeway to the Secretary of State, so I will oppose that amendment. I think the amendments that the hon. Member for York Central and I have tabled are preferable.
To make the obvious case for those amendments, and as I said in a previous debate, there are three choices in the event of failure. The first is to ignore the plain signs of distress, of things going wrong and of the patient suffering, which is clearly a failure of the doctor’s duty of care. The second is to expedite the death, which we have decided would be illegal under the Bill. Therefore, the only option is to revive the patient and escalate treatment, rather than actively or passively facilitate their death.
I hope Members will agree that, on the rare occasions when assisted suicide goes wrong, it is right that the patient is immediately revived and taken to hospital, or for the doctor to take whatever action is necessary. I am interested to understand why those amendments should not be supported.
Daniel Francis (Bexleyheath and Crayford) (Lab)
It is a pleasure to serve under your chairship, Sir Roger. I will speak to amendments 429 and 430 in my name. During oral evidence, we discussed the issues in subsections (9) and (10) of clause 18 and whether there is a contradiction. Subsection (9) states that the co-ordinating doctor
“must remain with the person”
and subsection (10) says:
“For the purposes of subsection (9), the coordinating doctor need not be in the same room as the person”.
We also discussed how that works in other jurisdictions. My amendment 429 would deal with that conflict. If the Bill were to become law, that conflict could be queried.
We also need to consider the possibility of complications. Clearly, if there are complications and the doctor is not in the same room, they would not necessarily be aware of those complications. I accept that, in some normal circumstances, doctors and medical professionals are not present in the room at the time of death; at other times, they are present. The amendment would mean that if something were to go wrong and someone was having a painful reaction to the drugs, the doctor would be there to see and help.
I do not understand what the Bill means when it says the doctor does not have to be in the same room. How far away would the doctor have to be? One subsection says the doctor has to remain with the person, and the following subsection says they do not have to be in the same room. If the Bill were to pass, we would be asking doctors to do something that is unprecedented. If the person were to suffer complications such as seizures or vomiting, or if they were exhibiting signs of distress, it appears that the doctor should be present. Members may think this could encroach on a patient’s privacy, but I think there is a discrepancy between the two subsections.
On amendment 430, I am conscious that my hon. Friend the Member for Ipswich has tabled a similar amendment. The intention of my amendment is to ensure there are regulations in responding to any unexpected complications that arise in relation to the administration of the approved substance, including when the procedure fails. I am conscious that if a doctor intervenes, they could end up in breach of the Suicide Act 1961. I therefore left the wording in that vein, as I understand that we will receive more information in due course.
Again, we received oral evidence from a number of people that what a doctor is meant to do in the event of unexpected complications is a matter of concern from both a legal and a medical perspective. We know from the evidence received from other jurisdictions that—I accept in a small minority of cases—there can be complications or the death can take much longer than expected. We also received evidence that, on rare occasions, death can take days.
Amendment 430 would show we have thought about those circumstances and provided for them by giving doctors a code of practice to refer to, rather than being left in the dark if a difficult situation arises at the time of death. We must not find ourselves in a circumstance in which doctors and patients are unprepared. It is important for us to think through, provide for and safeguard against all possible scenarios, however rare they might be. Of course, we would not want them to happen, but in some circumstances they might, and we would not want there to be a legal hole. Accepting the amendment would mean the Secretary of State has the opportunity to provide a code of practice for such circumstances. I hope hon. Members will be able to support the amendments in my name.
Sarah Olney (Richmond Park) (LD)
It is a pleasure to serve under your chairmanship, Sir Roger. I support amendment 429, tabled by the hon. Member for Bexleyheath and Crayford.
I do not understand how subsection (9) can require the doctor to remain with the person until they have self-administered and died, or until they have decided not to self-administer, while subsection (10) states that the doctor need not be in the same room. The Bill becomes even less coherent when we consider subsection (11), which requires the doctor to remove the substance immediately if the person decides not to self-administer—how can the doctor do so if they are not in the same room? Amendment 429 would make the scheme more coherent and I support it for that reason.
I accept that there are downsides to having the doctor present, especially before the administration, as people have a normal desire for privacy, but that needs to be balanced against the risk of someone else taking the substance or something going wrong in the process of self-administration. In Australia, there is no requirement for the doctor to be present, which has led to some cases of abuse. I understand why the Bill’s promoter has chosen not to go down the Australian route, but the position arrived at in subsection (10) lacks coherence and is unclear.
What does it mean to remain with the person without being in the same room? Does it mean being in the corridor just outside the room, but with the door open? What if it is closed? What if, as a result of the door being closed, the doctor is no longer within earshot? I am not the only one who is confused, as so are the doctors who will have to apply the legislation. For example, Dr Janet Menage, a retired GP, told us in written evidence—TIAB 182—that the provisions
“are mutually exclusive: doctor ‘must remain with the patient’ but ‘not in the same room’…This makes no sense. In any case, if the attending doctor is not in the same room there could potentially be an intervention by another person to the patient’s detriment. Or the patient may wish to cancel the suicide at the last moment and be unsupported in voicing that decision.”
With or without subsection (10), I would like to know whether the Minister has made an assessment of the workforce impact of such a requirement for the doctor to be present. As Dr Rebecca Jones told us:
“As the death may take many hours, I’m uncertain of the practicalities of this”.
Sean Woodcock
The hon. Lady is making an important point about the lack of coherence that amendment 429 is trying to sort out. Throughout these weeks of debate in Committee, we have heard about the importance of clarity for practitioners. This provision introduces severe doubt as to exactly what a practitioner is meant to do. I understand that we do not want to say, “You have to do this and this, and in this order”, and that amendments have been rejected on that basis, but this clause opens a massive loophole in the law and practice, which concerns me. Does the hon. Lady share my concern?
Sarah Olney
The hon. Gentleman is absolutely right. It is fundamental that, with this legislation, we provide very clear guidance to the medical practitioners who will be engaged in assisting patients with this matter. This is not only for their peace of mind that what they are doing is acceptable under the law, and accords with what Parliament has decided, but for the protection of patients. It is incumbent on us to be really clear about what we mean, and I do not believe we are as the Bill is currently drafted.
Sojan Joseph
We repeatedly talk about doctors, but nurses, healthcare assistants and other professionals will definitely be involved in a hospital environment. The Bill does not talk about other professionals. Furthermore, within a hospital environment, NHS wards may be bays without individual bedrooms. Does the hon. Lady think we need to be clearer on the procedures that will happen in those areas?
Sarah Olney
I am grateful for the hon. Gentleman’s professional experience, which is extremely helpful. He is absolutely right. Following the point made by the hon. Member for Banbury, we cannot define the circumstances in which a patient will find themselves when this is taking place. That is why it is incumbent on us to make sure we provide very clear guidance on precisely what Parliament intends.
As Dr Rebecca Jones told us in written evidence:
“As the death may take many hours, I’m uncertain of the practicalities of”
doctors remaining with the patient
“for many doctors…have competing demands on their time.”
In written evidence, Dr Chris Ainsworth asked how this will work in cases where death takes several days, as has happened in Oregon, while Dr Trevor Stammers wrote:
“If the doctor is required to be present until the patient’s death, this may require hours of practitioners’ time to fulfil and is unlikely to be adhered to in many cases if the dying process is protracted.”
Dr Rachel Fisher said in her written evidence that for Australian doctors, who are not required to be present at the final act, each assisted death requires around 60 hours of professional time. For British doctors, we will need to add the time it takes for the self-administration to result in death. Dr Fisher also raised the real impact on doctors, writing,
“imagine the practicalities of those who must deliver it. The GP, motivated by a deep desire to preserve life and relieve suffering arrives at the home of the patient with a cocktail of powerful drugs. What if the patient has symptoms? Who will collect their child from nursery or school if the patient takes a long time to die? How will they know when to decide the death was unsuccessful? Will there be counselling for GPs observing and feeling complicit in a potentially drawn out and symptomatic death?”
Finally, Dr Paul Shaw asked in his written evidence:
“How will this service be funded? What support will be required from the NHS when things go wrong or death takes longer than expected? Will this be a 0900-1700hrs service? What will be the out of hours arrangements?”
A lot of the written evidence touches on the practicalities of a doctor being required to remain with the patient until they die. Amendment 429, in the name of the hon. Member for Bexleyheath and Crayford, seeks to clarify whether “being with the patient” requires the doctor to be physically present in the room.
Sarah Olney
The hon. Gentleman gives me an opportunity to conclude my remarks. I support amendment 429 because it is important to provide clarity that when we say “with the patient,” we mean in the room. However, I invite the Minister to expand further on the resource requirement of assisted dying. I want the doctor to remain with the patient, which I think is critical. That is why I support amendment 429, but the implication of the Bill is a considerable resource requirement, particularly for GPs, and I would like the Minister to respond to that.
Jack Abbott (Ipswich) (Lab/Co-op)
I rise to speak to amendments 532 and 533, standing in my name, and in support of amendments 429 and 430, tabled by my hon. Friend the Member for Bexleyheath and Crayford. I appreciate that my amendments are similar to amendment 430. They go a little bit further, but probably not as far as we have previously discussed in the Committee.
I totally understand the concerns about the Bill being overly prescriptive about the regulations that could be passed down to the doctors making such decisions. However, it is important that we enable the Secretary of State to provide guidance, in addition to GMC regulations, on what the co-ordinating doctor must do if the procedure has failed. At the moment, the Bill simply states:
“The coordinating doctor must remain with the person until”
that time. However, I appreciate that amendment 429, if passed, would cover that issue.
Clause 9 states:
“The assessing doctor must…discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance under section 18”.
However, the Bill as drafted is not clear about what a doctor is legally permitted to do in the event of such complications. That is particularly important, as the Bill expressly states that the final act of administration must be taken by the person themselves. Therefore, the Bill as it stands stipulates that the doctor must discuss the patient’s wishes in the event of complications without stipulating what actions the doctor can take in such an event and thus what the patient’s options actually are.
There is a gap in the Bill and a lack of clarity on that critical issue, which has been raised frequently in both written and, to an extent, oral evidence. Dr Alexandra Mullock argued that, as
“the Bill would only permit”
a doctor only to assist in the patient’s self-administering a substance,
“administering drugs to end the life of a patient who might be unconscious (but not dying) is not permitted.”
She also raised the possibility that a patient might regain consciousness, but
“be too ill to make a second attempt”
at self-administration. What should a doctor do if that occurs? Unless the Secretary of State clarifies what a doctor can do in that situation—my amendment would not do that; it would merely give the Secretary of State direction to do so—the co-ordinating director could be placed in a difficult position.
Professor Alex Ruck Keene argued that the Bill as it stands could lead to the potential for medical professionals to be “required to stand by”, yet without being able to take steps to respond to complications so as to ensure that the process is completed. I fully appreciate that all doctors would use their good training, common sense and years of extensive practice to make a best-case judgment, and we would always support them in that, but the Bill has the unintended consequence of not giving doctors true cover in that area.
Dr Mullock also asked what should occur if the patient survives a procedure, “but is badly affected”. What treatment should be provided? Should the patient be moved to hospital? Should the patient be sedated or made comfortable until a natural death occurs, or should the doctor be able to take steps for the patient to die following the initial failed attempt? We need answers to those questions. Amendment 532 does not seek to answer them, but it would stipulate that the Secretary of State must do so at a certain point.
Danny Kruger
The hon. Gentleman is making an excellent speech, setting out the gap at the heart of the Bill. Does he agree—I think that he does, as he has just explained it—that there are quite straightforward choices: to expedite a death, which is illegal; to do nothing, which is inhumane; or to treat, revive or resuscitate? Why does he think that should not be clearer in the Bill? Why does he want to leave it for the Secretary of State to determine that in the future? Why do we as Parliament not get to decide what the right options should be?
Jack Abbott
I appreciate the hon. Gentleman’s question. In short, the answer is because we are not medical professionals. [Interruption.] Well, some members of the Committee are medical professionals, but not all of us are. I do not think that it is for the Committee to make a judgment on whether to put that in the Bill. I am happy and comfortable to leave such a directive and further recommendations, in addition to the GMC guidance, as further work to do in the coming months and years ahead of the Bill’s implementation. I think that is a healthy and strong thing to do. This is an important compromise to some of the conversations we have had in this Committee over the weeks. The amendment seeks to give a clear direction that these sorts of regulations and procedures should be stipulated at some point down the line.
Danny Kruger
The hon. Gentleman suggests that this is something that should be left to the medics. Nevertheless, here we are legislating for medics to be able to administer lethal drugs to people; we are responsible for what happens subsequent to the administration. Let me put this another way: does the hon. Gentleman foresee any scenario in which the guidance from the Secretary of State could be anything other than that the patient should be revived and helped to live in the circumstances where there are clearly complications under way? What else could be the appropriate direction given by the Secretary of State?
Jack Abbott
I appreciate the point that the hon. Gentleman is trying to make. We have discussed this point at length, across a range of subject areas, but we cannot legislate for every single permutation that could possibly happen. That could be about the initial conversations, when the patient is given a terminal diagnosis. Where do those conversations leave us? Clearly there will be a number of different scenarios, which could occur to various degrees.
I do not think it is possible to legislate for every single eventuality. I do not believe that whether to revive or not revive will be so black and white; it will completely depend on the scenario at that particular moment in time. Therefore, further work would need to be done over the coming months and years before the final introduction of the Bill. I believe that it is important to allow the time for that work to happen alongside the existing guidance as it stands.
I do not seek in my amendment to stipulate exactly what every single permutation might be—indeed, that could run to many pages and beyond. The amendment seeks to empower the Secretary of State and the Department to make sure that those eventualities, and the concerns that the hon. Member for East Wiltshire has raised, are covered by regulations over time.
In my view, the failure to provide a clear answer to these questions is an oversight. Data from Oregon shows that it is unfortunately not totally uncommon for patients to suffer complications following the administration of a lethal substance. In 2023, of the 102 patients for whom we have data on whether they suffered complications—out of a total of 367 patients who died by assisted death in Oregon in that year—10 suffered complications. That is just under 10% of the patients we have data for.
Of those 10, eight had difficulty ingesting the substance or regurgitated it. One suffered a seizure, and for one we have no data of what complications occurred. If I may say so to the hon. Member for East Wiltshire, that goes back to the variances that I referred to. It is not as simple as whether to resuscitate or otherwise. There are a number of different factors. Although that is a relatively small sample size, it shows the diversity of the challenges ahead.
In Oregon, information about complications is reported only when a physician or another healthcare provider is present at the time of death, which means that we evidently have less data on this issue than is desirable. However, despite the small sample size, that data would put the complication rate at one in 10. It would not be a completely uncommon occurrence for patients to experience complications following the administration of a lethal substance, although it would be rare.
Kim Leadbeater
My hon. Friend is referring to Oregon. Obviously every jurisdiction has its own methodology when it comes to assisted dying. Is he reassured somewhat by the evidence from Dignitas that for not one person did the procedure fail? A survey from Victoria in Australia showed that 1,076 deaths from the self-administration process took place, and 86% of patients died within one hour. There are different models, and it is important to look more broadly at this if we can.
Jack Abbott
I fully accept my hon. Friend’s points, and I agree. To reiterate, complications are not a regular occurrence by any means. They are relatively uncommon. In saying that, there are still 10% of people who did experience them. As she says, these complications are not huge, but there were issues with being able to ingest the substance or with regurgitating it. The figure of 86% that my hon. Friend refers to is absolutely correct, but that would suggest that for 14% of people it took longer than an hour. In my view, that is a relatively high percentage for what we are talking about here.
As I say, my amendment does not seek to stipulate in the Bill exactly what measures have to be taken in every single scenario. I am not suggesting for a moment that we have to legislate about what we must do in the event that, for instance, someone has difficulty ingesting the substance; I am sure that will come naturally with the GMC regulations. I fully appreciate the points made about how this will probably naturally occur, but it is important to provide a reassurance that we are looking at the long-term effects in such scenarios.
Sojan Joseph
Does my hon. Friend think that 10% is a high number? Does he also think that if we informed patients about the side-effects of those medications from the beginning, the number of patients opting out would probably be higher?
Jack Abbott
I thank my hon. Friend for the question; I agree that 10% is a statistically reasonable figure and should be noted, which is part of the reason for my amendment. However, this is still relatively uncommon from the small sample sizes we have. For example, while it is important to refer to the Oregon example, the sample size is only 100 people, so we should always keep that in context. Will fewer people choose to go down that path because they feel, for example, there is potentially a small chance they might struggle to ingest the substance? To be perfectly honest with my hon. Friend, that will completely be their personal choice, and it is really important that, in every stage of the process, we are very clear with those looking to go down this path about what those eventualities might be.
Everyone will take their own personal opinion about that, but we want to be very clear about any risks that might come about, and we have already stipulated that this will be part of the process. Everyone should be very clear about the process—what it will look like and the associated risks. Many people will look at this and still say, “This is the path for me”, but that of course will be their own judgment.
Danny Kruger
I wonder whether, in the hon. Gentleman’s view, it might be appropriate for the Secretary of State, when framing the guidance he requests, to leave it to a doctor’s discretion. Would that be an appropriate outcome that he would be happy with? My concern is that we will end up with a Bill that has a blank space when it comes to what should be done in the event of complications, as it does currently, and that the Secretary of State might find it equally confusing and unclear and might be reluctant to specify too precisely what should be done in the range of different circumstances that the hon. Gentleman has mentioned. Will we not end up with a further passing of the buck to clinicians to make that decision? Given that, is it not even more appropriate at this stage for us to give a direction to the Secretary of State stipulating that, whatever the guidance will be, it is entirely inappropriate for a doctor to expedite the death of the patient in any way?
Jack Abbott
In the case of this Secretary of State, he is more than happy, as we have seen in the last week or so, to take decision making back in-house and make them himself as well, although that is perhaps a separate political point.
Jack Abbott
Absolutely, I know. I am sure the Committee supports him as well.
I would also point the hon. Gentleman to proposed new subsection (13), which my amendment 532 would introduce, saying what “specific actions” can legally be taken, for example, if
“there is a greatly prolonged time to death”,
the person has been “rendered unconscious” or
“the person is otherwise undergoing complications.”
That quite clearly states that we expect the Secretary of State, through this amendment, to take specific co-ordination actions on that. Under proposed new subsection (12) alone, the Secretary of State would have to make provision on that, which could lead to what the hon. Gentleman is alluding to. However, what I propose in proposed new subsection is very clear: that we would expect specific actions from the Secretary of State in that area.
Naz Shah
My hon. Friend is making an important speech. He talked about percentages earlier. Is he aware of a study in the Netherlands that concluded that 21 people—18% of the cases in the study—were assisted with lethal injection? In five of those cases, that was because the person could not swallow, but in the rest, they were unable to complete.
Jack Abbott
I have used the statistic of 10%; we might find additional statistics from different jurisdictions that put that figure slightly higher or slightly lower. The point I am trying to make is that this is a relatively uncommon occurrence; none the less, this is an area of the Bill that we can make stronger with additional provisions.
I will make some progress on amendment 532. I have made the basis of my point and want to get on to amendment 533. As I have said, amendment 532 seeks to provide clarity on what doctors can do if the procedure fails or is failing by stipulating that the Secretary of State must specify in regulations what actions the co-ordinating doctor can legally take if there is a prolonged time to death; if the person has been rendered unconscious or unfit to make a second attempt at self-administration, but has not died; or if the person is undergoing complications following the initial attempt.
While there is existing GMC guidance, if no further guidance comes forward in the coming years, we risk placing some doctors in an incredibly difficult position. We always say that we should abide by good practice and the experience of many doctors, but additional cover is no bad thing. We need to say what doctors are legally permitted to do in the event of a patient undergoing severe complications. Leaving aside the doctors, that presents a risk to the patient, who may suffer needlessly and intolerably because the co-ordinating doctor does not know what they are legally allowed to do and is thus seeking to avoid legal ramifications of actions. We do not want them to take steps to respond to those complications or support the patient to die in a painful manner.
I will speak briefly to my amendment 533, which is about where assisted dying can take place. The Committee has already touched on that, and I do not want the Bill to be too prescriptive, which is why I have not stipulated exactly where the locations should be. However, this question was raised a number of times in the submitted written evidence. It is incredibly important that we address this question to ensure that assisted dying takes place at a certain location and does not have a detrimental effect on that location or community, and that the implementation of assisted dying does not exacerbate existing healthcare inequalities or deepen the mistrust of the healthcare system that exists among some ethnic minority communities in particular.
We have a duty to ensure that anyone seeking an assisted death under the Bill feels that it is safe to do so, is able to experience the positives of assisted dying and is not traumatised or retraumatised by the process. That is not possible if assisted dying takes place in settings in which people feel unsafe, which they feel unable to control or in which they have no agency. The amendment seeks to ensure that the question of where assisted dying can take place is properly addressed and that the possible impacts of assisted dying taking place at any particular location are fully considered. Only then can we address and mitigate its possible detrimental impacts.
That is a particularly important point because the criterion in the Bill that the doctor must remain with the patient until they have died realistically precludes assisted dying taking place at home, as there may be a prolonged time to death. As my hon. Friend the Member for Spen Valley said, 86% of patients in Western Australia died within the hour, but 14% took longer than that. To use another comparison, in Oregon, 87.7% of those who died via an assisted death in 2023 did so at home. If we are essentially precluding assisted dying from taking place at home because of the stipulation that a doctor has to be in attendance, we must answer the question of where it can take place.
In written evidence, Sue Ryder and the National Care Forum cited concerns about the impact on the wellbeing of staff and the other residents of hospices and accommodation-based services, should assisted dying take place within those communities. Dr Jamilla Hussain, in arguing that the question of where assisted dying could take place needed to be addressed, stated that her consultations with
“ethnic minority groups across Bradford highlighted the risk that AD could significantly deepen mistrust in healthcare services, including but not limited to palliative care.”
She argued that that needed to be considered when determining where assisted dying would take place, and because of that it would be preferable to avoid
“healthcare settings that these communities rely on, such as hospitals and hospices.”
Again, amendment 533 does not seek to specify where assisted dying should take place—I think further work is possibly needed over the coming months and years before this policy is potentially implemented—or to prohibit any particular location, I must add. The rationale behind the amendment is to ensure that through extensive consultation with relevant parties, the possible impacts of assisted dying taking place at any particular location are fully and comprehensively considered, and thereby any potential harm is addressed and mitigated against.
Jack Abbott
I was just finishing, but the hon. Gentleman has timed it perfectly, so I will.
Danny Kruger
I think the hon. Gentleman is right about this one. Does he agree that the hospices that have written to us have a very valid point of concern that they might be required to facilitate assisted dying on their premises, even if many members of staff or other residents do not wish that to happen? Does he agree that it is important that we protect hospices from having to have anything to do with assisted dying?
Jack Abbott
I appreciate that point. Throughout this process we have spoken about the absolute need to ensure that very good palliative care options are being presented to everybody along this pathway. I do not think you can separate care homes and hospices from the Bill, but I fully appreciate and sympathise with what the hon. Gentleman is saying. As I have said, there may be some hospices that are simply not appropriate for this, so although amendment 533 does not seek to put that on the face of the Bill in terms of precluding any particular areas of our healthcare system, it would require the Secretary of State, through consultation, to make sure that the legislation is used properly, and make suitable recommendations.
Naz Shah
I rise to speak to amendment 436, tabled my hon. Friend the Member for York Central. The amendment concerns what would happen after a patient has suffered complications while going through the administration of lethal drugs. Let me stress that we know that people suffer complications when they are undergoing assisted deaths. Unfortunately, one thing we do not know is how common those complications are. Another thing we lack is data that would allow researchers to investigate whether certain drugs, perhaps in combination with certain medical conditions, were more likely to cause complications.
The reason that we do not know those things is because of the many gaps in the data collected in places that have assisted dying laws. It has been mentioned before, but very much bears mentioning again, that the Australian states’ reports on assisted dying do not publish data on complications suffered by patients who self-administer drugs, and that is the overwhelming majority of assisted deaths in Australia.
Western Australia’s most recent report does tell us how frequently there were complications in the cases that involved practitioner administration of lethal drugs—4.3% of those deaths were affected. I understand that the Bill does not allow practitioner administration, but that is not the relevant point. What is relevant is that first, the Australian data shows that some people given lethal drugs suffer complications, and secondly, those complications were ones that we would not wish on someone in their last minutes or hours of life. For example, five out of 198 practitioner administration deaths involved “other complications”, which included people coughing and/or reporting a burning throat after they were helped to swallow drugs,
“hiccups with gastric reflux, involuntary muscular contractions, and delayed loss of consciousness.”
Western Australia could be much better than other states on average in avoiding complications, or it could be worse. I am afraid that we really do not have the robust data that would allow us to make those comparisons. I repeat: the Australian state does not publish data on complications affecting the majority of assisted dying cases. They do not because they cannot, since no one is mandated to stay with the patient and observe their condition. We do not know, therefore, how common those complications are.
Record-keeping in other jurisdictions is also concerning. This House’s Health and Social Care Committee examined the records kept by the state health department in Oregon while inquiring into assisted dying. They found that Oregon authorities kept very poor records into how many patients suffered complications and what those were.
Amendment 436, tabled by my hon. Friend the Member for York Central, would take a very different approach. Under this amendment, the doctor attending the person having an assisted death would have to make “a detailed record” if the person suffered complications. They would then have to declare that the person had suffered complications, on the final statement concerning that case. Finally, they would have to make a report, to both the chief medical officer for either England or Wales and the voluntary assisted dying commissioner.
Dr Opher
I am glad to serve under your chairmanship, Sir Roger. First, I will briefly address the whole area that we are talking about. GPs who are involved in terminal care will go and see a patient as they are slowly dying; we do not know at any point what will happen, and almost anything can happen. I have sat with people who may at any point have a massive pulmonary haemorrhage and drown, for example, or they may just quietly go to sleep—or they may start vomiting.
What those of us in terminal care do is react to what is happening with the patient. For example, if they start to be sick, we would give them an anti-emetic; if they start to become very agitated we would then give them midazolam. What I am saying is that this is normal medical care. We have to be very careful not to stipulate in the Bill what is actually normal medical care.
I understand that what we are proposing is a new option that has not been there before, and we know that there are complications. But in a terminal situation, there would be no occurrence where we would call an emergency ambulance and take them to hospital, for example.
Sean Woodcock
My hon. Friend speaks with a lot of knowledge, and every time he contributes I learn something about the medical profession. My challenge to him is that while he is right that at the end of someone’s life GPs and doctors are used to looking after somebody, and there are lots of different complications from medical treatment, in the situation we are talking about the treatment—if we can call it that—is to end their life. That is a distinct difference. Something has gone wrong if their life has not ended suddenly or peacefully, as they were hoping. That means that they might die hours or days later, potentially in agony, or they will linger on, potentially also in agony. The amendment is to try and clarify what then happens, because I would suggest that this is very different from a normal medical procedure.
Dr Opher
I thank my hon. Friend for his sensitive and clear worry. But it is important to note that we would not in any circumstances try to do something that would finish someone’s life after they had been given their self-take medicine, because that is against the law. In the Bill we have made a clear distinction between the doctor—a euthanasian, if you like—taking the life, and the patient taking medicine that finishes life. What we need to do is simply support the patient. If, as my hon. Friend suggests, they are in pain we would give them a morphine drip, which is in common use in terminal care. I absolutely respect what he says, but the same treatment principles would be in place as in terminal care.
Danny Kruger
Even in terminal care, when it is understood that a patient is close to death, doctors would surely not overlook a patient for whom an assisted death is clearly failing. The hon. Gentleman suggests that it would be inappropriate to—and that he would never—call an ambulance, or send a patient to A&E; I wonder whether he also means that he would never seek to revive a patient or bring them back to life, as it were, if they were experiencing complications. To his often-repeated suggestion that there is no difference between this and normal medical treatment, there is an enormous difference. Doctors administer lethal drugs to a patient, and are then also supposed to be somehow caring for the patient in the traditional way that doctors should. These things are inherently incompatible, and there is a choice between the two : is the doctor helping the patient to die, or is he helping them to live? That questions remains, and does he not acknowledge that there will be circumstances where it would be appropriate to revive the patient, and seek to support them as if they were living?
Dr Opher
I almost agreed with the hon. Gentleman earlier, when he asked at one point, should we not just leave this to doctors?
One of the key things the hon. Gentleman said is that the doctor administers the drug. This is self-administered, first of all, so that is a very clear line. However, also, in a case of terminal care—this is what I am trying to get across to the Committee—we know the patient is dying, and therefore if they are becoming worse we simply do things to make them comfortable, and we do not try to revive them, because they are dying. It is important that we realise that this is a very different medical situation from normal care, and that it actually needs very different skills as a doctor. Here, a doctor is not trying to prolong life, but trying to make a death as comfortable as possible.
That is why I support the Bill—because I think it will enhance a comfortable death. I wanted to make it clear that that is normal practice now in terminal care: we do not revive a patient with a terminal diagnosis who is in terminal care, but we make them comfortable.
Sojan Joseph
This is a very good discussion, and with a clinician as well—maybe my hon. Friend can help here. Are we leaving the Bill to professionals to administer, who might be confused and not clear about what they should be doing? In normal current practice, when somebody has a poor prognosis and is very fragile; we use “do not resuscitate” or “do not attempt CPR” decisions. Why do we not build that into the Bill—that everyone who is going through this process should have a DNR or DNACPR in place?
Dr Opher
I thank my hon. Friend for his experience in a clinical setting. I would remind everybody that in the Bill we are trying to help people die in a comfortable way, and I do not feel it is the Bill’s job to define exactly how we treat nausea or abdominal obstruction and so on. What we would like to do here is ensure that a patient has a pain-free death, and a death that they are in control of.
Dr Opher
I will make a little progress and will then take my hon. Friend’s intervention.
On amendment 436, all medical practitioners are required under their code of practice to record any event they come across. I feel there should be better data and I agree with the hon. Member for East Wiltshire that we need to collect data. We are actually very good at doing that in the NHS. Under clauses 21 and 22 there are provisions for the Secretary of State to collect data on complications. I am therefore not sure that particular amendment tabled by my hon. Friend the Member for York Central is necessary. I think I have covered amendment 464, from the hon. Member for East Wiltshire.
On amendment 429, about the doctor being in the same room, I totally understand the anxieties presented by my hon. Friend the Member for Bexleyheath and Crayford, but I feel that whether the doctor is there should be the choice of the family and the patient. There may be some confusion about this, but to me, what the Bill implies—I am interested to hear the Government’s opinion—is that the doctor should deliver the medicine to the patient, check that the patient is willing to take the medicine as per amendment 462 from the hon. Member for East Wiltshire, give the medicine to the patient, and then ask the family whether they want them to be there or in the next room. They need to be available, but do they need to be in the same room? I think that should be the choice of the family.
Daniel Francis
I hear what my hon. Friend says, but the wording of clause 18(9) and (10) is ambiguous. Subsection (9) says that the co-ordinating doctor must remain with the person until “the person has died”, but subsection (10) says that the doctor
“need not be in the same room”.
I do not want to get into measuring metres, but where exactly is that place? Is it in the same room or is it in the same building? If it is in the same building, you cannot possibly be with the person until they die. Does my hon. Friend have comments on that?
Dr Opher
I am interested to hear what the Government say about the wording around that amendment and whether it is safe. I would defer to the Minister on that.
Amendment 430 from my hon. Friend the Member for Bexleyheath and Crayford, about a code of practice that must address complications and failures, is quite a strong amendment and I am willing to support it. If as doctors we have a code of practice about how we handle this type of thing, the amendment would potentially help, and perhaps answer some of the questions from my hon. Friend the Member for Banbury.
I do not believe that amendment 255 from my hon. Friend the Member for Filton and Bradley Stoke is necessary. I believe it should be dealt with under clause 21.
I believe that the very well put amendments 532 and 533 from my hon. Friend the Member for Ipswich could be covered by amendment 430.
Dr Opher
I am in two minds about the doctor being present until the patient dies. In the circumstances, we need to encourage this to happen at home predominantly, because I think that is where most people would prefer to do this action. We perhaps need to look further at whether the doctor needs to stay, in the rare situation where the patient goes on.
Let me conclude by saying that I know that the amendments all come from a good place, and that this is an anxious time, but terminal care is an anxious time for doctors, for patients, for everyone, because we do not know exactly what is going to happen. The Bill allows someone a way of dying, when they have a terminal illness, that has a bit more exactitude than normal practice.
Jack Abbott
I fully understand and am very sympathetic to my hon. Friend’s point about the family having privacy and space in the last moments. However—this is a genuine question—what happens if things start to go wrong? Although it is uncommon, we know it is possible. Do we expect the family members who are going through the last traumatic moments to have to go out of the room to find the doctor, albeit they might just be behind the door? I do not know that that would necessarily make it less traumatic, and for some people it could make it worse if the doctor is not there and present next to their bed.
Dr Opher
I think there is some truth in that, to be fair, but I believe we should leave it open to the family’s discretion, with the proviso that the doctor should be close at hand, whether that means outside the door or whatever. We need Government advice on whether amendment 429 is safe. I have nothing further to say.
Lewis Atkinson (Sunderland Central) (Lab)
It is a pleasure to serve under your chairship, Sir Roger. I will cover a few of the amendments, and follow on from my hon. Friend the Member for Stroud, whose points I broadly agree with.
When it comes to the location and, actually, a lot of the elements, I fear we are trying to over-specify practical matters. As in so many cases, this is not about capacity, coercion, assessment and so on; it is about the practicalities of death, and it is right that we allow the healthcare team for dying people and their families to operate with the professional skill with which they currently operate.
On amendment 429, on the doctor being in the same room, I can think of many instances in healthcare in which a healthcare professional is in an adjoining room, potentially even with a door open so there is a line of sight, and that is entirely appropriate. I think of observations, for example, in various settings. That provision is absolutely necessary and allows an appropriateness of proximity without intrusion. I am sure the doctor will be in the room at the point at which the substance is taken, but if someone then goes into unconsciousness fairly quickly, as would happen in the vast majority of cases, and then takes half an hour or so to die, it is entirely unnecessary for a doctor to be standing there in the same room, towering over the family, when they could be near at hand. I just do not think we need to specify that in the Bill.
I have some sympathy with amendments 532 and 533, tabled by my hon. Friend the Member for Ipswich, on the Secretary of State setting out regulations, but I fear the hon. Member for East Wiltshire did an excellent job of persuading me that they should not be accepted, because when a “must” is included in that way, we get into saying, “The Secretary of State must tell a doctor exactly what they must do in every situation.” The legal parameters are clearly set out in the Bill as drafted. There is no administration by a doctor on a person’s behalf; it must all be self-done. Additionally, we have not yet mentioned the existing provisions in clause 9(2)(c), which requires, at the point of assessment, a conversation between the assessing doctor and the patient about their wishes in the event of complications or any sort of delay.
Jack Abbott
I appreciate what my hon. Friend is saying about the Secretary of State not stipulating every dot of every i and cross of every t in the regulations, but we are talking about something that has not been practised in this country, so we do not have existing guidance anywhere about what to do in this event. My hon. Friend may correct me, but I think it is really important that the Secretary of State has to give some direction through regulations on what a doctor is able or not able to do in these situations. I appreciate that there must remain room for a doctor’s best-case judgment in certain situations but, from a legal perspective and otherwise, the Secretary of State and the Department will have to give some thought to exactly how the regulations work.
Lewis Atkinson
To me, amendment 430, tabled by my hon. Friend the Member for Bexleyheath and Crayford, strikes the right balance. Under clause 30 the Secretary of State “may” make provision for codes of practice on these matters if that is required; I am uncomfortable with saying that the Secretary of State “must” do so, when it is likely that it will be more appropriate for the GMC or some other body to make those regulations. We get into a difficult precedent if the Secretary of State must specify the reaction in certain medical circumstances but we routinely leave that to medical regulation and practice more widely. I think a “may” power, as set out in amendment 430, would allow that backstop provision, but would not get into the issue of “must”. It is also likely to be more respectful of the conversations as outlined in clause 9.
Sarah Olney
I am listening to what the hon. Gentleman is saying, and a lot of what he is talking about in terms of giving doctors discretion makes a lot of sense in a routine medical intervention, but this is not a routine medical intervention. This is a very serious point, and the doctor’s judgment in this case could well fall either side of what is permissible by the law. That is why it is so important that it is really clear. Whether we decide in Committee that it must be on the face of the Bill, or whether we want, as per the hon. Member for Ipswich’s amendment 532, to leave it to the Secretary of State, it must be clear and specific.
Lewis Atkinson
I think the Bill is very clear on the legal parameters. A doctor may not act, in terms of administering the substance, in a way to hasten death. Within that, we are back into the realms of normal medical practice, as my hon. Friend the Member for Stroud set out. I am sure that there will be legal guidance, whether that be from the GMC or elsewhere, if and when the Bill were to pass. The Secretary of State would have the powers anyway under clause 30, but for the avoidance of doubt, amendment 430 strikes the right balance in giving backstop permissions to the Secretary of State to clarify anything if needed.
Kim Leadbeater
On the hon. Member for Richmond Park’s point, which a couple of people have made, I do not think anyone is saying that this is not a new situation—of course it is, as we are all aware. My hon. Friend the Member for Stroud’s point was that a doctor being with a patient who is dying is not a new situation. That is the important distinction.
Lewis Atkinson
My hon. Friend is absolutely right and articulated that better than I was managing to.
Danny Kruger
We are not necessarily talking about someone who is dying right here and now in consequence of the drugs they have taken—we could be talking about someone who is many months away from their death. The scenario we are envisaging is that fatal drugs —poisonous drugs—have been administered to the patient’s body and we are asking doctors to be normal doctors in that scenario. In a genuinely normal scenario of doctors being doctors, they would attempt to revive the patient and to save their life in that circumstance. If the parallel is with the last moments of someone’s natural death, the doctor’s job is simply to make them comfortable, but that it is not the scenario. The scenario is some months away from their natural death, when they have months to live. They may not even be exhibiting extreme illness—they may just have a terminal disease. If they have been given fatal drugs, what on earth is the doctor to do in the scenario where the drugs are not working? Surely that is a question for all of us, rather than just leaving it up to the doctors.
Lewis Atkinson
I disagree. As clause 9 makes clear, the doctor will have had a conversation with the patient about their wishes in advance, in exactly the same way as a surgeon would have a conversation with a patient in advance of high-risk surgery—
Lewis Atkinson
I am not going to take any further interventions; I am going to answer this point and make some progress.
The surgeon would say, “If this procedure fails, would you wish me to attempt resuscitation? Would you wish to be put on a support system?” The hon. Gentleman misunderstands current practice on consultation with patients, in advance of procedures, about their wishes, which is where there is significant established evidence.
Lewis Atkinson
I am going to finish on this point.
On amendment 533, tabled by my hon. Friend the Member for Ipswich, I suspect that, in dealing with a later clause, we will have a conversation about issues around hospices and care homes, but again I find the requirements under the amendment unduly onerous. As my hon. Friend the Member for Stroud and others have said, often people’s preferred place of death is at home. Are we really saying that the Secretary of State would specify addresses or the nature of places where these procedures should take place?
Jack Abbott
No, is the short answer to that question. Because a doctor has to be present, are we saying that doctors have to go to someone’s home to administer this? Would the Secretary State say, for example—this is not my personal view; it is for discussion—that it would have to take place in a medical facility, or could people choose to have an assisted death at home? The amendment stipulates that the Secretary of State would have to give that guidance at the time. I do not see how we can have doctors going out to individuals’ homes to assist the process.
Lewis Atkinson
It is by no means clear that doctors would not go out to people’s homes, but my hon. Friend asks whether doctors would have to do that—there are no powers of compulsion anywhere in the Bill, because the entire model is an opt-in model at every stage, including the example he gave in respect of hospices. It is a matter between the resident of the home and the treating medical practitioner.
In reality, healthcare procedures do not happen ubiquitously: they happen in appropriate places with appropriate cultural sensitivity. We do not specify in primary legislation for that to happen. Health professionals, and those involved in the management and commissioning of health services, currently have ample opportunities to co-ordinate and consider such matters.
Jack Abbott
I appreciate my hon. Friend giving way again. For people in the Committee and our colleagues across the House, there has to be clarity. Perhaps it is a question for the Bill promoter’s and the Government. As I said, I have no personal problem with it, but is there an expectation that assisted dying will take place at home as well as in medical facilities?
Lewis Atkinson
I cannot speak for the Bill’s promoter or for others, but a significant number of people wish to die at home.
Kim Leadbeater
I can help my hon. Friend out on this point. There is an expectation in the jurisdictions where assisted dying happens that it happens in different locations, very much centred around the patient’s wishes, which is the approach we should take.
Lewis Atkinson
That is exactly right. That will quite possibly include people’s individual homes as well as not in their homes, in places of appropriate care and peace and tranquillity.
Kit Malthouse
The hon. Member might be interested to know that many hospices and, in fact, the hospice movement have developed what they call hospice at home, which is for people in the advanced stage of illness who want to die in their own home. Services are provided to them to palliate them as they reach death at home.
Lewis Atkinson
The right hon. Gentleman is absolutely right. Another point we have not yet mentioned is that the Care Quality Commission regulates healthcare on the basis of location of delivery. Hospice services cannot just be provided from a random place: the place has to be registered with the CQC as suitable for the provision. I am sure that regime would continue in this instance.
Stephen Kinnock
Amendment 435 would require the co-ordinating doctor to escalate the care of an individual to the appropriate emergency medical services if the assisted dying procedure has failed. Requiring the co-ordinating doctor to make a referral may engage article 8 of the European convention on human rights—the right to family and private life—if the person has indicated that they do not wish to be referred to emergency services or do not wish to be resuscitated. In a situation where the procedure has failed, doctors would, as in their normal duties, support a person in line with their professional obligations and their understanding of the person’s wishes. This could include the involvement of the emergency services, but it would be unusual to specify a particular approach in legislation.
As currently drafted, clause 18(9) provides that:
“The coordinating doctor must remain with the person”
once the approved substance has been provided, until either
“the person has self-administered the approved substance and…the person has died, or…it is determined by the coordinating doctor that the procedure has failed”,
or, alternatively, until
“the person has decided not to self-administer the approved substance.”
Amendment 429 would remove the clarification currently provided for in clause 18(10) that the co-ordinating doctor does not have to be
“in the same room as the person”
once the approved substance has been provided. However, clause 18(9) requires the doctor only to
“remain with the person”.
It may still be possible that the co-ordinating doctor could remain with the person but in a different room if they decide that is more appropriate.
Amendment 436 would increase reporting obligations on the co-ordinating doctor in cases where complications have occurred. It is not clear in the amendment what would be considered a complication and therefore trigger the reporting requirement. It is also not clear what details should be set out in the person’s medical records or in the report to the chief medical officer and voluntary assisted dying commissioner.
Naz Shah
I am struggling with this. When amendments were tabled last week, there was a concise direction from the Minister that he understood the intention of the amendments. Could that approach not be applied to these amendments—that there is an understanding of the intention, and they can be tidied up in the wash-up process to make them tight? Could that not happen?
Stephen Kinnock
My job and that of my hon. and learned friend the Justice Minister is to defend the integrity and coherence of the statute. The concern that we have with the word “complication” is that it is a wide-ranging term and concept, and its inclusion could potentially undermine the integrity of the legal coherence of the Bill and how it could be interpreted in terms of its implementation. I am simply flagging the risk that if the Committee chooses to accept the amendment, there could be a muddying of the waters in terms of its meaning in law.
Rebecca Paul
Following on from the point made by the hon. Member for Bradford West, has the Minister taken into account the guidance on private Members’ Bills? It says exactly what the hon. Member has just set out: the spirit of amendments should be taken, and it is for the Government to ensure that the integrity of the statute is respected with the final version. That is to allow a free-flowing discussion and to ensure that we capture everything we need to in the Bill, in the light of the fact that many of us are not lawyers or experts.
Stephen Kinnock
Absolutely, if the Committee chooses to accept the amendment, it goes into the Bill. If the Bill gets Royal Assent, it becomes the responsibility of the Government to ensure that the Bill, as passed by Parliament, is implemented in the best possible way.
The hon. Lady is right that the Government’s responsibility is to take on whatever passes through Parliament and implement it to the best of our ability. My job in this Committee is to raise concerns about risks of amendments that could potentially muddy the waters more than other amendments, or more than the Bill as it currently stands. It is a balanced judgment about whether we are better off with the Bill as it currently stands, whether the amendment would improve the Bill, or whether it could lead to concerns about the integrity of the statute if it were included.
Rebecca Paul
I thank the Minister for that explanation. I suggest it would also be appropriate for him to set out the changes that could be put in place in order for the amendment to work in that way. To my mind, that would give the true neutrality that he is seeking to achieve. Rather than set out why something does not work, he could set out how it could work in order to deliver the spirit of the change.
Stephen Kinnock
I think what I am saying is that the word “complication” contains a multitude of potential interpretations and meanings. The work that would need to be done by the Government to unpack it and understand what it means certainly could be done if the amendment passes, but the Government are saying that, as it stands, it is not clear. The drafting of the amendment is so ambiguous that it causes the Government concerns about its inclusion.
Naz Shah
This is a genuine question because I continue to struggle with this. What kinds of complications would we envisage if a lethal drug is being administered to a patient who has chosen assisted dying? What kinds of examples are there? Can the Minister help me understand?
Stephen Kinnock
With all due respect, I think it is more the responsibility of those who draft and table amendments to draft and table them in a way that leaves no room or as little room as possible for ambiguity. I think my hon. Friend would be better off addressing her question about the potential complications to somebody with clinical expertise, who could list off a series of potential physical manifestations. I am not qualified to do that. I do not have a clinical background so I am not able to answer her question.
Amendment 464 would impose a duty on the co-ordinating doctor not to do anything with the intention of causing the person’s death and to seek to revive the person if it appears to them that the procedure is failing. It is unclear what “appears to be failing” would mean, and what criteria would need to be met for the co-ordinating doctor to consider the procedure to be failing. It would be unusual for primary legislation to seek to mandate a clinical course of action in the way proposed by the amendment. In addition, the amendment could potentially create conflict for the co-ordinating doctor if the person has a “do not attempt cardiopulmonary resuscitation” order or a legally effective advance decision is in place, as the doctor would have to resuscitate them even if they had stated wishes to the contrary. That could give rise to engagement of article 8 of the European convention on human rights on respect for private and family life.
Amendment 532 would introduce a new duty on the Secretary of State to make regulations setting out what the co-ordinating doctor is legally permitted to do if they determine that the procedure under clause 18(2) has failed. Under the amendment, the regulations would also include specific actions that the co-ordinating doctor can legally take if there is a greatly prolonged death; if the person is unconscious and unable to make a second attempt at self-administration; or if the person has other complications. If specific actions that the co-ordinating doctor can legally take are set out, there is a risk that, when complications arise, they would be unable to take actions that are not listed. That may lead to uncertainty and restrict what the doctor can do, using their professional judgment, to respond to particular circumstances. It is unusual to set out a particular clinical approach in primary legislation.
Amendment 533 places a duty on the Secretary of State to make regulations specifying where the provision of assistance under the Bill may take place. It sets out a requirement on the Secretary of State to
“consult such persons as the Secretary of State considers appropriate”
prior to making such regulations, including certain specified groups.
I turn to amendment 430, which would broaden the Secretary of State’s power to issue codes of practice under clause 30 of the Bill. It would explicitly enable the Secretary of State to issue a code of practice in connection with
“responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails”.
Naz Shah
I respectfully point out that the Minister says that it is not for him to make interpretations and that he has not got the clinical expertise. I genuinely appreciate that, but I am also trying to understand why he accepts provisions that are not clear in the Bill. Why is he okay with those but not with the amendments?
Stephen Kinnock
My hon. Friend will have noted that a number of amendments have been drafted in collaboration with the Bill’s promoter, my hon. Friend the Member for Spen Valley. I think that demonstrates that when the Government have seen a lacuna, a lack of clarity or ambiguities in the Bill, officials, along with the Justice Minister, my hon. and learned Friend the Member for Finchley and Golders Green, and I, have worked with my hon. Friend to table amendments to tighten up the Bill. We are doing that in areas where we feel that ambiguity exists. However, when we feel that the Bill, as drafted, does not give rise to such concerns, our position on the amendments is according to our position vis-à-vis the current wording of the Bill.
Danny Kruger
The Minister said that the Government find it impossible to understand the word “complications” —that it is too complex and full of ambiguity. Yet in clause 9 of the Bill, we have that very word. The suggestion is that the doctor should
“discuss with the person their wishes in the event of complications”.
Is that unclear? If not, what is the difficulty with specifying “complications” in clause 30?
Stephen Kinnock
The challenge with amendment 436 is that the policy intent is not as clear as it is in clause 9. That clause is about conversations in advance of decisions about committing to the procedure, whereas when it comes to complications that have arisen in a rapid and fast-moving situation, the view of the Government is that it is adequate to rely on the professional judgment of the medical practitioner to take the decision that best suits that situation.
One is a conversation that can be explored between the clinician and the patient in advance, in a managed environment; the dialogue can take place in a considered manner. The second situation is one in which there is a particular physical manifestation and it is up to the clinician to take a rapid position and to decide, according to all the elements that they usually use, such as the GMC’s “Good medical practice”, other codes of practice and their own professional judgment.
Danny Kruger
The Minister suggests that it is appropriate for the patient to give some advance indication of what should be done in the event of complications, but that it would not be right for Parliament, too, to give advance direction of the sorts of responses that would be appropriate in the circumstances.
I am afraid that I do not understand the Minister’s distinction. Either it is possible to set in advance the sorts of responses that would be appropriate in the event of complications—the word “complications” is already in the Bill, so is clearly acceptable—or it is not. In the event of complications arising when the patient has not given clear instructions in advance, surely it is appropriate for the doctor to be able to rely on guidance, whether that is in the Bill or set out by the Secretary of State subsequently.
There needs to be clarity about what to do because, to repeat the point, this is not normal medicine—a fatal drug has been introduced into the body. That is not a normal medical situation in which a doctor just uses their clinical judgment; the only appropriate clinical judgment in such circumstances is to attempt to save the patient’s life, because that is what doctors are supposed to do. But we are telling them that they have been allowed to help a patient to die artificially. In that circumstance, what are they supposed to do when that is clearly not working?
Stephen Kinnock
How amendment 436 is drafted makes for a real challenge, because it is not clear what detail should be set out in the person’s medical records or in the report to the chief medical officer and the voluntary assisted dying commissioner. There is ambiguity in the drafting of the amendment.
Kim Leadbeater
To try to tie this together, I should say that there seems to be consensus that something has to be recorded in the event of complications. It feels to me as though what the Government are saying is that this is not the best crafted way of doing that—that is the worst sentence ever; I apologise. We have to look at the best way of achieving the intention of a number of amendments. I am looking at amendment 430, which I think achieves the objective. This feels as though it is a drafting issue, rather than necessarily a policy issue. I might be wrong.
Stephen Kinnock
Of course, if we can find ways to improve the Bill, we should—that is what this Bill Committee is for. But the input from my officials and parliamentary counsel legal advice have raised red flags about the amendments because of how they are drafted and the ambiguity that they give rise to. Clearly, it is up to the Committee to decide whether it wants to include the amendments or whether those issues could be looked at later—either on Report or when the Bill is going through the other place.
Naz Shah
We cannot have things both ways. I have re-read amendment 436 and I am not convinced that the issue is the drafting. It is very clear:
“If complications occur as a result of the provision of assistance the coordinating doctor must…make a detailed record of the complications…make a declaration…and…make a report”.
I am struggling to differentiate between having a conversation about it and it actually happening—it is still a complication, so why the resistance? Can the Minister agree that the Government will look at this and, perhaps in the wash-up, tidy it up—if that is the issue, and they agree in that instance?
Stephen Kinnock
Fundamentally, the role of the promoter of the Bill is to decide whether the Bill, as passed through this Committee, meets the policy intent that she wishes to achieve. Our job as Ministers is to work with her to deliver that objective. If the promoter of the Bill comes to the view that any of the amendments should be considered and added to the Bill, we will of course work with her to enable them to be delivered. My job at the moment is simply to say that there are concerns about these amendments due to the issue of ambiguity.
Kim Leadbeater
As a matter of clarity, although I appreciate the power that the Minister has just given me, which amendments we vote for is actually the job of the Bill Committee—rather than just my job, I would hope.
Stephen Kinnock
Absolutely, it is the job of the Committee to decide which amendments pass, but my hon. Friend’s role as the promoter of the Bill is to define the policy intent of the Bill—its fundamental objectives, the fundamental safeguards issues and its architecture in that sense. It is absolutely the responsibility of the Bill Committee to decide whether to amend the Bill.
Sarah Olney
I hope the Minister can answer a question for me. I hear what he is saying about concerns with the amendments themselves, which makes a lot of sense, and the policy objectives of the hon. Member for Spen Valley. What I am concerned about is that in the Bill as drafted, notwithstanding that various amendments have been tabled, it is not clear what the doctor should do in the event of complications. There may well have been an earlier conversation with the patient, but the patient’s request may still leave the doctor in the position of committing a criminal offence.
I would like to know whose responsibility it is to ensure that doctors are not left in that position, which could come about either because the Bill as drafted is not clear or the amendments do not make the appropriate clarification. The hon. Member for Spen Valley has done a marvellous job, but in terms of policy intention the Bill does not cover this aspect. The Minister is saying that it is his job only to ensure that the amendments are appropriate. I am still very concerned that there is a big gap here and that we are potentially leaving doctors in the very difficult position of not knowing whether or not carrying out the patient’s intentions would leave them in the position of breaking the law. I would like to know whose responsibility it is to ensure that doctors are not left in that situation.
Stephen Kinnock
The hon. Lady will know that we rely on medical practitioners to make professional judgments all the time. My hon. Friend the Member for Stroud has set out the range of things that medical practitioners can do when they are dealing with end-of-life care. That happens all the time.
In these circumstances, it is the view of the Government that we should continue to rely on the skill, judgment and expertise of medical practitioners, underpinned by the various codes of practice—the GMC, or good medical practice, being probably the most obvious one. There is an understandable desire to use primary legislation to address issues of this kind, but it is important to point out that that could prove to be counterproductive and that we could end up with a Bill that becomes less workable and therefore potentially less safe—what one might call the law of unintended consequences.
Sarah Olney
The Minister is talking about somebody making a medical judgment, which would obviously be the right thing to do in the normal course of events, but we are talking about a doctor being left in a position of not knowing whether to take a further step that would end somebody’s life or to take the step that would be natural for a doctor—to try to revive the patient. This is about what the legal position is in that case—it is not a matter for medical judgment.
Stephen Kinnock
My response would be to refer the hon. Lady to clause 30(1), which sets out that the Secretary of State will produce a code of practice. Amendment 430, which my hon. Friend the Member for Spen Valley has said she is minded to support, would also ensure that the code of practice includes guidance on the matter that the hon. Lady raises. I think there is a commitment to a code of practice, and if amendment 430 passes then it would be explicitly in the Bill that that code of practice should include the issue that she raises.
Amendment 533 places a duty on the Secretary of State to make regulations specifying where the provision of assistance under the Bill may take place. It sets out a requirement on the Secretary of State to consult such persons as the Secretary of State considers appropriate prior to making such regulations, including certain specified groups.
Amendment 430 would broaden the Secretary of State’s power to issue codes of practice under clause 30. It would explicitly enable the Secretary of State to issue a code of practice in connection with responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails.
I understand that amendment 255 is no longer relevant as it relates to schedule 6, which is going to be changed—I think that is right—so, in that sense, the amendment is null and void. I hope that those observations were helpful.
Kim Leadbeater
I thank colleagues for a thorough discussion of a group of interesting and important amendments. Amendment 429, tabled by my hon. Friend the Member for Bexleyheath and Crayford, would require the doctor to remain in the same room as the person. I respectfully disagree with my hon. Friend on that point. If a person is literally in the last few minutes and moments of their life, it should be up to them to decide who is in the room with them. In some cases, that might be the doctor, but I suspect that in many cases it would be loved ones and close family members.
We have had a thorough discussion of the range of amendments that look at how we deal with complications. My view is that amendment 430 would do what needs to be done. We need the Bill to show that this has been considered, and the logical place for that would be clause 30, on codes of practice. I am happy to support that amendment when the time comes to vote on it.
Danny Kruger
The Minister suggested that there will be a code of practice, but clause 30 says that there “may” be a code of practice. Does the hon. Member accept that there might not be one and that, even if there were, the only obligation on professionals would be to have regard to such a code? There is a big difference between that and a stipulation in the Bill.
Kim Leadbeater
I believe that amendment 447, tabled by my hon. Friend the Member for York Central, would change the “may” to a “must”. I am minded to support it for that very reason.
Amendment 532, tabled by my hon. Friend the Member for Ipswich, comes from a good place as is meant to be a way of trying to help the doctor, but I worry, as medical colleagues have commented during our deliberations, that it could create more of a problem for the doctor in that it would remove flexibility and the use of their clinical judgment and expertise. It always worries me when we are considering putting that level of detail in the Bill.
Jack Abbott
I appreciate what my hon. Friend is getting at in terms of what might happen down the line, but the amendment would not restrict any doctor’s flexibility at all or bind them in any way. All it would do is ask the Secretary of State to form a set of regulations.
Kim Leadbeater
The challenge would be in whether the co-ordinating doctor would be able to take actions that were not listed. I worry that a list would be quite restrictive. Amendment 430, which would look at the code of practice, would achieve something in a less restrictive way, which is why I am minded to support it.
We have had a really interesting discussion about amendment 533, and we will probably come further down the line to discuss where patients should have the choice to have an assisted death. I am not entirely sure how the amendment would work, which is why I am not minded to support it.
I am slightly concerned about the terminology and am not sure what the definition of “disadvantaged and marginalised communities” would be for the purposes of the amendment. I refer my hon. Friend the Member for Ipswich to new clause 8—the duty to consult—bearing in mind that there will be a long period of consultation before the Bill, if it passes, is enacted.
The Minister referred to amendment 255, which I think will fall as it refers to a schedule that has been removed from the Bill.
Danny Kruger
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Chair
I am satisfied that the matters arising from clause 18 have been fully debated. I therefore do not propose to have a stand part debate.
Question put, That the clause, as amended, stand part of the Bill.
Kit Malthouse
On a point of order, Sir Roger. Is there any chance somebody could attend to the heating? I do not know whether I am the only Member who is starting to feel a bit cold. As the evening wears on, we are likely to get colder. If we could have it turned up slightly, that might assist our proceedings.
The Chair
I was under the impression that cold concentrated the mind, but we will see what we can do. I speak as one who will not be in the room. The point has been taken.
Clause 19
Authorising another doctor to provide assistance
Sarah Olney
I beg to move amendment 408, in clause 19, page 13, line 18, after “provided” insert “has been consulted and”.
The amendment ensures the person has been consulted before they have given consent for another medical practitioner to be authorised to provide assistance.
The Chair
With this it will be convenient to discuss the following:
Amendment 210, in clause 19, page 13, line 22, at end insert—
“(2A) Regulations under subsection (2)(b) may in particular provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.”.
This amendment enables regulations under subsection (2)(b) to provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.
Amendment 499, in clause 19, page 13, line 25, at end insert—
“(3A) Where a registered medical practitioner who is authorised under subsection (1) is not satisfied of all of the matters mentioned in section 18(4), they must notify the coordinating doctor immediately.”
This amendment provides that where a practitioner authorised under clause 19(1) is not satisfied of all of the matters mentioned in clause 18(4), they must immediately notify the coordinating doctor.
Amendment 22, in clause 19, page 13, line 32, at end insert—
“(5A) Regulations under subsection (2)(b) must specify that training in respect of domestic abuse, including coercive control and financial abuse is mandatory.”
This amendment would require that, in the event of the coordinating doctor authorising another registered medical practitioner to provide assistance under the Act, that other registered medical practitioner must also have undertaken training on domestic abuse, including coercive control and financial abuse.
Clause stand part.
Sarah Olney
Amendment 408 seeks clarity on a critical aspect of the legislation. Clause 19 allows a co-ordinating doctor to authorise another registered medical practitioner to carry out their functions, providing that the patient consents and that the replacement has completed training, qualifications and experience as specified by the Secretary of State. This is a facilitation clause to smooth the process, and in some cases it might seem like something that we should just nod through. If the co-ordinating doctor becomes unwell, takes leave or faces an emergency that prevents them from fulfilling their duties, they might delegate to ensure continuity of care for the patient. If the patient relocates, perhaps to be closer to family, or if the co-ordinating doctor cannot travel to the patient’s location due to the distance or logistics, a local practitioner could be authorised to step in, provided they meet the specified requirements and the patient consents.
Naz Shah
I rise to speak to amendment 499, tabled by my hon. Friend the Member for Spen Valley. Let me outline what the amendment does and why I believe that it provides an inadequate safeguard. Under clause 19, the co-ordinating doctor may authorise another doctor to provide assistance—meaning that they will help the patient to take the lethal drugs. For clarity, I will refer throughout my speech to this other doctor who may step in to provide lethal drugs as the second doctor.
Under clause 18(4), the co-ordinating doctor must be satisfied of three conditions before they proceed to assist the person to take lethal drugs. Those three conditions are that the person has a clear, settled and informed desire to end their life, has capacity under the Mental Capacity Act 2005, and is not subject to coercion. Implicitly, the co-ordinating doctor can therefore end the procedure if they are not satisfied that those conditions apply. Under clause 19(3), the second doctor has the same duty as the co-ordinating doctor to be satisfied of those conditions before the assisted dying procedure can go ahead.
Amendment 499 would impose a new duty on the second doctor: if they suspected coercion, lack of capacity or lack of clear, settled and informed desire, they would have to inform the co-ordinating doctor. I suggest that the amendment does not take things far enough. It is a very serious matter if any doctor, be it the co-ordinating doctor or the second doctor, suspects coercion, lack of capacity or lack of desire. That means that a very serious mistake may well have been made, and that mistake could lead to someone having an assisted death who should not have qualified for it.
There should be several more safeguards in this part of the Bill. First, let us consider a situation where there was no previous suspicion that a patient had been coerced but where the doctor now suspects that they may have been. There should be a proper system of notification for such cases. It is true that doctors have a duty of care for patients, but it is also true that, given our overstressed, underfunded social care, health and policing systems, difficult cases sometimes fall through the cracks. The Bill should have a clear system for an authority to check back with the social care authorities and a person’s GP to make sure that steps are being taken to protect them from potential coercion. Secondly, the report that the second doctor makes in those circumstances should go to not only the co-ordinating doctor, but the voluntary assisted dying commissioner. Thirdly, when that happens, the commissioner should investigate the incident.
To repeat: if a doctor originally assessed a patient as qualifying for an assisted death, but a second doctor could not support that assessment, that is a serious incident that could lead to the assisted death of someone who should not have qualified for it. That does not mean that the co-ordinating doctor was necessarily at fault—not at all. The co-ordinating doctor will have been taking very difficult decisions under considerable stress. However, it does mean that the proper authorities should investigate the initial assessment, whether it was wrong and, if so, why it was wrong.
We see something similar with the Air Accidents Investigation Branch, which investigates not only accidents, but near misses that could have caused serious accidents. It does not assume fault when it investigates near misses. Often, it finds that there has been no human error. However, it has a statutory duty to investigate serious near misses. That is because the law passed by this House recognises that we need to understand why they happened in order to prevent fatal accidents from ever happening in the future.
For that reason, I do not think that my hon. Friend’s amendment is sufficient to fix the problems with this part of the Bill. I hope we can think about how better to address those problems, but I cannot support the amendment.
Rebecca Paul
I rise to speak in support of amendment 408, in the name of the hon. Member for Broxtowe. I also support amendments 499 and 210, in the name of the hon. Member for Spen Valley, and amendment 22, in the name of the hon. Member for Lowestoft (Jess Asato).
Clause 19 states that
“the coordinating doctor may authorise, in writing, a named registered medical practitioner to carry out the coordinating doctor’s functions under section 18…A registered medical practitioner may be authorised under subsection (1) only if…the person to whom the assistance is being provided has consented, in writing, to the authorisation of that practitioner”.
I support amendment 408, which adds that the person must also have been consulted.
I am sure the Committee recognises that, even where someone has basic training and the experience specified, delegating care at the end of life is something that must be done with great care, given the vulnerability of patients. If a co-ordinating doctor has guided someone through this profound and significant process, there are some intrinsic risks that come with delegating the administration of the final approved substance to someone else. I concede that there will be situations where a substitute may be required, but it will not be the doctor that the patient has trusted, confided in and relied on.
A new doctor will of course do the final checks for capacity and consent, but they do not necessarily have any specific detailed knowledge of the patient and may be unable to pick up less obvious cues that someone who knows the patient may be better able to. That gap matters, and history shows that it can lead to problems. The risks of delegation are well documented. If we take the Mid Staffordshire NHS foundation trust scandal in 2005 to 2009, detailed in the Francis report, consultants often delegated tasks to junior staff or nurses without adequate supervision, which contributed to poor care and an estimated 400 to 1,200 excess deaths. Patients suffered from neglect, untreated infections, dehydration and medication errors. That was partly because delegated staff lacked the training or authority to act decisively, and consultants failed to monitor effectively.
In surgical contexts, delegation can also falter. A 2006 Daily Mail report highlighted NHS payouts exceeding £1 million for wrong-site surgeries, where consultants delegated preparatory or operative tasks to trainees or assistants, who then misidentified sites—for example, operating on the wrong leg or tooth. Those errors often stemmed from inadequate briefing or supervision, pointing to a systemic delegation risk. We have to be really aware of this.
Those examples suggest that when consultants delegate, whether to junior doctors or other practitioners, including their peers, things can go wrong if communication breaks down, or if the replacement lacks equivalent expertise or is simply not aware of some of the detailed information. In order to manage some of the risks better, patients must be consulted about who takes over their care, and not just asked to consent after the co-ordinating doctor has decided what will happen.
Dr Shastri-Hurst
Given that valid consent requires a voluntary and informed decision, can my hon. Friend set out why that would not involve being consulted on the matter in any event?
Rebecca Paul
I would like to think that that would naturally happen, and we have had lots of conversations where we have said, “In reality, of course this conversation would happen.” But I always like to be belt and braces, and I would like to have these things covered in the Bill. If Committee members are confident that these things would happen anyway, I am not sure there would be any detriment to accepting this amendment.
I want to finish with a question for the Ministers. I have been worried—perhaps unnecessarily—about the lack of photographic identification in this process, and I can see a situation where allowing another doctor to provide assistance could create a risk. Although it might be less of a risk in someone’s home, because it would probably be clear who the person is, I am worried about a doctor in a hospital or clinic being substituted in at the final hour with no photographic verification of the person. At the point where they assist the patient to take the approved substance, how can the doctor be sure that it is the appropriate person if they have not had any involvement with the patient before? I accept, given some of the deep sighs I can hear, that that may be a rare occurrence, but it is worth thinking about. The simple inclusion of a photographic ID check would address some of that risk. I will not go over old ground, but I have been worrying about that.
Naz Shah
I rise to support amendment 22, in the name of my hon. Friend the Member for Lowestoft. Before I carry on, I am happy to give my hon. Friend the Member for Spen Valley the opportunity to say whether she will accept the amendment, because my hon. Friend the Member for Lowestoft has had a hat-trick of amendments being accepted around training on coercion.
Kim Leadbeater
I am very happy to accept amendment 22 from my hon. Friend the Member for Lowestoft, as it follows the theme of the previous amendments.
Naz Shah
I am grateful for my hon. Friend’s intervention, which will make my speech much shorter—I have repeated it at least three times on all the other amendments. While I welcome the amendment, I hope we can work towards something that strengthens the Bill even further.
Under the amendment, regulations would be made governing the doctors who could fill the role in the clause. Those doctors would have to undergo mandatory training in respect of domestic abuse, including coercive control and financial abuse. Giving doctors that training would not remove the danger that they will overlook evidence of abuse and coercion, but it should decrease it. The doctors we are talking about will spend less time talking to the person seeking assisted death than either the co-ordinating or the independent doctors. None the less, they will spend some time with that person, so I thank my hon. Friend the Member for Batley and Spen—sorry, Spen Valley; I keep going back to Batley and Spen, but we campaigned hard to get her elected there.
Stephen Kinnock
There are some amendments in this grouping—namely, amendments 210 and 49—that we worked on with my hon. Friend the Member for Spen Valley, and I will come to them later in my remarks.
If amendment 408 is passed, the person to whom assistance is being provided would have to be consulted before they consent in writing to another medical practitioner being authorised to carry out the co-ordinating doctor’s functions. All registered medical practitioners must uphold the standards set out in the General Medical Council’s “Good medical practice”, which requires registered medical practitioners to support patients to make informed decisions prior to consenting. Therefore, the proposed amendment may have relatively minimal impact.
Turning to amendment 210, clause 19(2)(b) sets out that a registered medical practitioner may be authorised to carry out the co-ordinating doctor’s functions only where they have
“completed such training, and gained such qualifications and experience, as the Secretary of State may specify by regulations.”
The purpose of the amendment is to provide that the required training, qualifications or experience are to be determined by a person or organisation specified in the regulations. An example of such a specified organisation might be the General Medical Council. Allowing for that to be specified in regulations rather than on the face of the Bill ensures flexibility.
Amendment 499 provides that where a registered medical practitioner who is authorised to carry out the functions of the co-ordinating doctor is not satisfied that all matters have been met, they must notify the co-ordinating doctor immediately.
If amendment 22 is made, regulations made by the Secretary of State on the necessary training, qualifications and experience of the named registered medical practitioner who is authorised by the co-ordinating doctor to carry out the co-ordinating doctor’s functions under clause 18 would need to include mandatory training relating to domestic abuse, including coercive control and financial abuse. The Committee has already made equivalent changes to requirements on training for the co-ordinating and independent doctors, so this amendment would bring the clause into line, should the co-ordinating doctor change, for the purposes of clause 18. Should this amendment be accepted, it would require setting up training mechanisms to equip registered medical practitioners with the knowledge and skills needed to identify domestic abuse, including coercive control and financial abuse.
On clause 19—sorry, I was going to refer to clause 19 stand part. That is the end of my observations.
Kim Leadbeater
Clause 19 applies when the co-ordinating doctor may not be available to provide assistance. They may be out of the country or unavailable due to other personal circumstances, as the hon. Member for Richmond Park articulated beautifully—I associate myself with her comments. Of course the doctor who steps in has to be trained appropriately, and if they are not satisfied of all the matters mentioned in clause 18(4), they must immediately notify the co-ordinating doctor. That is what my amendments 210 and 499 cover.
On amendment 408 in the name of my hon. Friend the Member for Broxtowe, who sadly is not with us today, it could be argued—and I take on board the comments by the hon. Member for Solihull West and Shirley—that it is unnecessary because it would be common practice by practitioners to consult. However, I also take on board the fact that the word “consultation” does some heavy lifting, and I think that is an important point, so I am happy to support amendment 408.
I have mentioned already in response to my hon. Friend the Member for Bradford West that I am happy to support amendment 22, for the reasons I have given previously in relation to similar amendments.
The Chair
Just before we move on to Sarah Olney to wind up the debate, I think I heard the Minister say, “No, that’s stand part.” Stand part is part of this grouping. Did the Minister wish to comment on stand part?
Stephen Kinnock
I did not wish to comment. That is why I sat down. I have said quite enough; I am sure everyone would agree.
The Chair
It was something else you were pre-empting yourself with—that is fine. I call Sarah Olney.
Sarah Olney
I have nothing to add.
Amendment 408 agreed to.
Amendments made: 210, in clause 19, page 13, line 22, at end insert—
“(2A) Regulations under subsection (2)(b) may in particular provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.”
This amendment enables regulations under subsection (2)(b) to provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.
Amendment 499, in clause 19, page 13, line 25, at end insert—
“(3A) Where a registered medical practitioner who is authorised under subsection (1) is not satisfied of all of the matters mentioned in section 18(4), they must notify the coordinating doctor immediately.”
This amendment provides that where a practitioner authorised under clause 19(1) is not satisfied of all of the matters mentioned in clause 18(4), they must immediately notify the coordinating doctor.
Amendment 211, in clause 19, page 13, line 31, leave out subsection (5).—(Kim Leadbeater.)
See the statement for Amendment 187.
Amendment made: 22, in clause 19, page 13, line 32, at end insert—
“(5A) Regulations under subsection (2)(b) must specify that training in respect of domestic abuse, including coercive control and financial abuse is mandatory.”—(Naz Shah.)
This amendment would require that, in the event of the coordinating doctor authorising another registered medical practitioner to provide assistance under the Act, that other registered medical practitioner must also have undertaken training on domestic abuse, including coercive control and financial abuse.
Amendment made: 212, in clause 19, page 13, line 33, leave out subsection (6).—(Kim Leadbeater.)
See the statement for Amendment 188.
Clause 19, as amended, ordered to stand part of the Bill.
Clause 20
Meaning of “approved substance”
Danny Kruger
I beg to move amendment 409, in clause 20, page 13, line 35, leave out from “specify” to “for” and insert—
“two or more drugs or other substances with different techniques of administration”.
The amendment requires that the Secretary of State specifies two or more drugs or other substances, which have different techniques of administration.
The Chair
With this it will be convenient to discuss the following:
Amendment 465, in clause 20, page 13, line 36, at end insert—
“(1A) A drug may only be approved under this Act if it has been approved by the Medicines and Healthcare products Regulatory Agency for that purpose.”
Amendment 466, in clause 20, page 13, line 36, at end insert—
“(1A) A drug may only be approved under this Act if the Secretary of State is reasonably of the opinion that there is a scientific consensus that this drug or combination of drugs, is effective at ending someone’s life without causing pain.”
Amendment 437, in clause 20, page 13, line 38, at end insert—
“(2A) The doses and types of lethal drugs specified in any regulations made under subsection (1) must be licensed by the Medicines and Healthcare products Regulatory Agency.”
This amendment would require that any drugs and doses to bring an end to someone’s life under the Act be licensed by the Medicines and Healthcare Products Regulatory Agency.
Amendment 438, in clause 20, page 13, line 38, at end insert—
“(2A) The doses and types of lethal drugs to bring about the person’s death must be recommended by either the National Institute of Clinical Excellence or the All Wales Medicines Strategy Group in Wales’ guidelines as appropriate prior to licensing.”
This amendment will require the doses and types of lethal drugs must be recommended by either the National Institute of Clinical Excellence or the All Wales Medicines Strategy Group in Wales as appropriate.
Amendment 467, in clause 20, page 13, line 38, at end insert—
“(2A) Regulations under subsection (1) are subject to the affirmative procedure and when tabling the draft of the statutory instrument the Secretary of State must at the same time lay before both Houses of Parliament a report setting out all relevant information on the likely time to death, complications and likely side effect.”
Amendment 482, in clause 20, page 13, line 39, leave out “negative” and insert “affirmative”.
Clause stand part.
Danny Kruger
I rise to speak primarily to the amendments in my name and those in the name of the hon. Member for York Central with respect to the regulations for the approval of the approved substances—the drugs that will be used in the procedure of assisted death.
My amendment 465 states:
“A drug may only be approved under this Act if it has been approved by the Medicines and Healthcare products Regulatory Agency”.
Amendment 437 in the name of the hon. Member for York Central would achieve a similar objective. My amendment 466 would require that the drugs
“may only be approved under this Act if the Secretary of State is reasonably of the opinion that there is a scientific consensus that this drug or combination of drugs, is effective at ending someone’s life without causing pain.”
I also support amendment 482 in the name of the hon. Member for York Central, which would move the approval of the regulations to the affirmative procedure.
Those who support this Bill argue that death through the administration of lethal drugs offers dignity and the avoidance of suffering. If that is to be the case, the drugs used must be effectively regulated and life must be ended effectively and without pain. The amendments I have mentioned specify the role of the Medicines and Healthcare products Regulatory Agency; in my view, to leave this entirely in the hands of the Secretary of State, as clause 20 does, is quite an extraordinary step. It feels remarkable that the Bill as drafted leaves this enormous question to the Secretary of State.
[Peter Dowd in the Chair]
Good afternoon, Mr Dowd; it is a pleasure to serve under your chairmanship.
Throughout the Bill, important questions are left to regulations made subsequently by the Secretary of State. I think that is inappropriate here. When patients are prescribed medicines, in most cases the medicine will be licensed by the MHRA for use for the treatment of the particular condition. Patients can be assured that the medicine has been evaluated by the MHRA to ensure that it meets safety and efficacy standards. The MHRA reviews clinical trial data, inspects manufacturing facilities, monitors post-market safety and conducts independent quality testing so that there is regulation of medicine.
I have two concerns with my own amendments here; they might have occurred to other hon. Members, too, if they are paying attention. First, I do not accept that the procedure we are debating here is in fact healthcare. The question then arises, “Why are you proposing that the healthcare regulator would oversee the administration of the drugs?” My response to that is, “Well, somebody’s got to do it.” In fact, we are talking about substances that might be used in a medical setting, that would be appropriate in other medical settings, and that will have an effect on the body comparable to that for which they are licensed for medicine. Obviously, the intention is the direct opposite: they are licensed for genuine medicine and healthcare in order to preserve life and treat symptoms, but the intention here is to eliminate life without reference to symptoms.
Nevertheless, the only appropriate authority in our country is the MHRA—unless we were to conceive of another new body that would have that specific responsibility. However, that body would have the same obligations that the MHRA does to ensure that the substance is safe, paradoxically, in the sense of not causing unwanted side effects or distress to the patient.
The second objection—there is no reason why hon. Members present would know about it, but I have spoken in the main Chamber before about my concerns about the MHRA—is that, while I have just cited all the work that the MHRA is supposed to do in the regulation of medicines and healthcare products, I am afraid it does not do that job well. I do not want to give the Committee the impression that I think we have a perfect regulator; I think we have a very imperfect regulator in all sorts of ways.
In fact, the hon. Member for Stroud and I have participated in debates on the regulation of antidepressants and addiction-forming prescribed drugs, an important debate in which he and I are on the same side. There is genuine concern about the way the health regulator operates—we will not get into covid vaccines and other things at this moment; we have enough on our plate.
Nevertheless, despite the problems with the MHRA and the fact that I do not want to give the impression that I am concluding that assisted suicide is in fact healthcare, somebody has to do this. We cannot allow a situation in which the patient takes an overdose of a drug with no controls to ensure that the drug meets quality standards and does the job that it is meant to do. A tablet that is licensed for prescription or sale would need to have a minimum level of purity of the active substance, and to be free from other substances and contaminants that might cause unpleasant side effects or reactions. Without regulation, there is a risk that the drug may fail to work as intended or may induce unwanted side effects, such as those that we are all concerned about.
The question is: what safety standards should apply to an approved substance used for the purpose of assisted dying? A drug used to bring about death is not curing or preventing disease, or alleviating symptoms to improve death.
Sojan Joseph
We had some discussion earlier about how we will potentially be assisting dying in people’s own homes—that was not previously known to us; we thought it would be always in clinical settings—so medication will be transported from where it is stored as a controlled drug, in a hospital setting, to the patient’s home. Does the hon. Gentleman think that it is important that we have clear guidance as to how we store this medication?
Danny Kruger
I entirely agree. The regulations need to specify not only what drugs may be approved, but, as the hon. Gentleman suggests, how they should be stored and transported. I would expect that to be part of the package of regulations under the Bill.
As I have stated, I do not accept that we are talking about healthcare here; nevertheless, we are using products that are comparable to health products. The MHRA would need to significantly adapt its work in order to identify the most effective drug to cause what we currently perceive as harm—namely, the death of a patient. I recognise that that would be a significant change of remit and work for the MHRA, but we need to do it. One of the reasons that we need regulation of approved substances is to help ensure that falsified versions of the drug—drugs that do not have a licence for use in assisted dying—cannot enter the market. Such drugs may not be effective and could cause distress to those ending their lives and their families. I would be grateful if the Minister could clarify whether, in his view, clause 20 is sufficient to establish the necessary regulatory regime, or whether further legislation will be needed.
We had evidence from Greg Lawton, and other pharmacists, who wrote to the Committee to suggest that the approved substances would not legally come within the definition of a “medicinal product”, so medicines law, the protections associated with medicines and the MHRA licensing process might not apply. If that is the case, what do we do about it? We need a new licensing regime to ensure that the MHRA is able to properly regulate the substances, or, potentially, another regulatory agency would need to be established to do the job.
The Committee needs to make sure that there is a process that applies to approved substances used for assisted dying. It is not necessarily the case that a product licensed for treating a medical condition could not be used to bring about death—it is not the case that we cannot use any drug that is currently used for genuine health treatment—but it would not be being used as a medicine, so medicines law may not apply to its use for that purpose. There is an ambiguity, and I would be grateful for clarity on it.
The amendments that I am supporting would ensure that the MHRA had approved the drug for the specific purpose of ending someone’s life, and that there was scientific consensus that the drug would be effective for that purpose. The MHRA, in the marketing authorisation for the approved substance, would define the dosage of the drug required to bring about death. It would also ensure that specific considerations and warnings were placed in the product licence.
For example, some patients have allergies to certain drugs. If they decide to end their own life, that should be brought about as a result of the effect of the drug, not an unintended allergic reaction to it. Some patients would not be able to take drugs orally and might need to have the drug administered through a tube into the stomach, so different formulations would need to be available. Some drugs may need to be administered by injection. Patients may be unable to do the injection themselves, as we have discussed. Even if the patient is physically capable, injection techniques require proper training, and that needs to be considered when licensing drugs for assisted dying if the patient is responsible for self-administration.
There will be further considerations when deciding what drugs can be used. Patients will have a right to know what to expect. If they take the drug orally, how long will they have to wait before they die? Will they lose consciousness first? If so, how long will that take? Could there be some side effects or reactions after taking the drug, such as seizures or choking, that the family or carers will have to deal with? Can the drug be taken at home—that relates to the point that the hon. Member for Ashford made—or must it be used in a clinical setting? We have suggested that it could be used at home, so questions about transportation arise. Is a combination of drugs required? If so, in what order should they be taken? What happens if the patient passes out before taking the entire concoction of drugs? Has the drug formulation been optimised for the purpose of assisted dying, so that it reaches maximum blood levels as quickly as possible?
All these sorts of questions are appropriate for medical regulators. The MHRA could ensure that the patient information leaflet, and the warnings associated with it, given with the drug when it is prescribed prompt doctors to think about what drugs are most suitable for the patient and to provide information to the patient about what to expect.
Parliament must have oversight. It must bear responsibility for the kinds of deaths that it approves. Both Houses of Parliament should approve the statutory instrument. To inform that decision, the Secretary of State should provide all relevant information on the likely time to death, and on complications and side effects. When the state is creating a regime that will end lives, there must be maximum transparency and accountability, yet the Bill provides that this will be done by a negative statutory instrument. In other words, Parliament will get a say on the regulations only if the Leader of the Opposition prays against them—that is the process for a negative SI. That is the only circumstance under which the Government would make time for a debate and a vote on a negative SI. Given that this is an issue of conscience, I find it inconceivable that the Leader of the Opposition would want to take a position on it and so pray against it to trigger a proper debate. I think it is highly likely that Parliament would never get a say on this crucial issue because of the use of the negative procedure.
That situation has been recognised repeatedly as being unacceptable. When Lord Falconer introduced his Assisted Dying Bill to the House of Lords in 2014, it too provided for a negative SI power on this matter. The highly respected House of Lords Delegated Powers and Regulatory Reform Committee—we do not have an equivalent Committee in the Commons, but it sits over Parliament—said that it did not consider either the power or the procedure in the Falconer Bill to be appropriate, yet that is the procedure that we are being presented with here.
In 2021, when Baroness Meacher introduced her Assisted Dying Bill to the House of Lords, the Delegated Powers and Regulatory Reform Committee again issued a report, in which it said:
“In the interests of clarity and transparency on such important issues of public policy, the matters that are in due course to be dealt with under clause 4(7) by negative regulations should in our view be spelled out in detail on the face of the Bill from the outset. Accordingly, the Bill should contain a definitive list of medicines, and details of the manner and conditions under which such medicines are to be dispensed, stored, transported, used and destroyed. The power to amend such matters should be a matter for regulations subject to the affirmative procedure.”
We then come to Lord Falconer’s 2024 Assisted Dying for Terminally Ill Adults Bill, which he withdrew following the introduction of this Bill by the hon. Member for Spen Valley. That Bill in part took on that feedback from the Lords Committee. Although it did not provide a list of medicines, it did at least provide that the power to specify the drugs would be through the affirmative procedure.
The Hansard Society, which is non-partisan and neutral on assisted dying, has issued a critical report on this power. It says:
“MPs may wish to enquire why Kim Leadbeater has chosen not to adopt the scrutiny procedure set out in the 2024 bill, but has preferred that proposed in the 2014 and 2021 incarnations of the bill, despite the advice to the contrary of the Delegated Powers Committee.”
I would be grateful to learn from the hon. Lady why she has chosen this procedure.
It might be objected that the list that I am requesting might need to be modified quickly and that the affirmative procedure—having a parliamentary vote—would be an obstacle to doing that. The Hansard Society anticipated that objection. It said that
“this could be addressed by making provision for the use of the ‘made affirmative’ procedure in urgent cases where the Secretary of State wishes to remove a substance from the approved list and is of the opinion that it is necessary to do so immediately in order to prevent adverse medical events or failed assisted deaths. This would mean Ministers could act expeditiously but Parliament would have to debate and approve – albeit retrospectively – the change in the list. Whilst not perfect it would provide more opportunity for oversight than that offered by the negative scrutiny procedure.”
It seems to me that there is no justification for this vital matter to be regulated under the negative procedure. Too much power and responsibility is being given to Ministers subsequent to the passage of the Bill— if that is what happens. My amendment 467 would ensure that Parliament has a meaningful say, through the affirmative procedure, and that a report is published as part of that process setting out the expected efficacy of the drugs that will be used. I hope that the Committee will support it.
Rebecca Paul
My hon. Friend the Member for East Wiltshire eloquently covered most of the things I would have said.
We have probably not spoken enough to date about the impact on pharmacists, but we are getting to the point in the Bill where it is really important that we take on board the written evidence and feedback that we are hearing from them. The Royal Pharmaceutical Society said:
“In dispensing a prescription, a pharmacist assumes a proportion of the responsibility for that prescription and therefore must be assured that all legal requirements are in place and that it is entirely appropriate for the patient. The link to the clinical assessment of eligibility criteria is essential and therefore the prescriber should always be one of the assessors. In addition to the usual practice of checking that the prescription fulfils the necessary legal requirement, pharmacists must have full access to the patient’s diagnosis and assisted dying care plan.”
That raises a few valid and interesting points that we need to take on board to ensure that pharmacists can do their jobs in line with the regulations and laws they are subject to, which are ultimately there to maintain patient safety.
I support amendment 466, tabled by my hon. Friend the Member for East Wiltshire, which would ensure that the Secretary of State must be of the opinion that there is scientific consensus that the drug is effective without causing pain. I am of the view that the Secretary of State is probably the right place for that responsibility to sit. One reason for that, which my hon. Friend spoke about, is that I am not sure that the MHRA is the right regulating body for that. I am no expert on this, and I am open to hearing the debate, but the MHRA’s remit covers medicines and healthcare products, so there is a question about whether legally the responsibility falls to it. If it does not, do we set up another body, or do we adjust its remit so that it is covered? I have reservations about doing anything that would merge assisted dying into normal healthcare, but I have laid that out many times over the weeks, so I will not go over that.
My understanding is that, on top of all the things my hon. Friend set out, the MHRA’s role is to give marketing authorisation for the promotion and advertising of medicine. Once that has been given, reams of regulations and compliance must be done, including in respect of the labelling of medicine. I believe it would have to be put on packaging that a medicine could be used for assisted dying. We need to get clarity on that from experts in the field, so that we fully understand it. If that is the case, how do we feel about making it clear that said medicines, potentially out in the market, could be used for assisted dying? I suggest there could be some significant downsides to such clear labelling. That is something for us all to think about. I wanted to raise those important points.
Naz Shah
I rise to speak in support of amendment 465, tabled by the hon. Member for East Wiltshire. It is a pleasure to follow the hon. Member for Reigate, who has made some powerful contributions. As we have heard, the amendment states that a drug may be approved under the Bill only if it has been approved by the Medicines and Healthcare products Regulatory Agency for that purpose.
Danny Kruger
The hon. Lady puts her finger on the tension—my hon. Friend the Member for Reigate and I expressed it as well—about whether it is appropriate to give the health regulator responsibility for regulating a product that is about not health, but death. Does the hon. Lady agree that no other agency would be appropriate, given the skills she has set out? The purpose of these lethal drugs is to kill the patient; nevertheless, it is appropriate that we consider them in terms of not only that objective but their potential side effects. The purpose is not one of healthcare, but the product is very close to a healthcare intervention. Therefore, despite all our anxieties, it feels appropriate for the healthcare regulator to oversee this.
Naz Shah
I absolutely agree and share those concerns. This is important. I appreciate that we have had this debate for many days now. Is this a healthcare intervention? Is it a treatment? What words should we apply? In this instance, when it comes to drugs, there are potential side effects. We have seen that they do not work everywhere and that they create complications. We have just debated whether a doctor should be in the room, outside the room or round the corner, as well as whether they should be visible or able to see what is going on. Ultimately, this is about the drugs. Having looked at the issue, I genuinely cannot imagine anything but the MHRA in this role. Are we really going to set up something completely new, outside our health service, that regulates drugs, their side effects and the potential implications?
Dr Opher
The matter of unlicensed drugs sounds very alarming, but we cannot regulate a drug through the MHRA if it unlicensed, and we would be looking for therapeutic effect, which would not apply in this case. More importantly, many other regulatory bodies, like the pharmacy framework and the General Pharmaceutical Council—
The Chair
Order. Remember that an intervention should be a sketch, not an oil painting. It should be a question or should seek clarification; it should not be a mini-speech.
Naz Shah
My hon. Friend clearly speaks with expertise. There are other regulators, but the reason why I support amendment 465 is that the MHRA is an institution that we trust and that has the expertise. My understanding—my hon. Friend might be able to tell me differently—is that, of the regulators, the MHRA is the body that does the ultimate rubber-stamping and gives our country confidence in the national health service.
Danny Kruger
The hon. Lady is right that there is no other agency that is appropriate. The difficulty is that the MHRA is itself highly conflicted—we will come in due course to discuss the role of the profit motive in this mooted procedure—and the big problem is that it is overwhelmingly funded by the pharmaceutical companies. We have to ensure that there is no hint of corruption in the system, but I agree with the hon. Lady that the only way to do this is through that agency, but perhaps after reform.
Naz Shah
I thank the hon. Member for his intervention.
We should be using the world-class pharmaceutical regulator we already have to oversee the drugs that will be used for assisted dying, and I urge all Committee members to support the amendment, which is a very important safeguard.
Stephen Kinnock
It is a pleasure to serve under your chairship, Mr Dowd.
The Government’s assessment of amendment 465 is that it would significantly impact the legal and operational delivery of the Bill. The Government anticipate that all substances used for assisted dying will have existing licences from the Medicines and Healthcare products Regulatory Agency for other indications, but the amendment would require the approved substances to be licensed by the MHRA specifically for the purpose of assisted dying. That would require additional powers or provisions to ensure consistency with the current legal framework. The Bill does not currently provide for that, so the amendment would create significant issues for the Bill’s operability.
Amendment 466 would require there to be scientific consensus regarding the efficacy of the substances to be used in assisted dying under the Bill. The availability of scientific evidence related to the substances used for assisted dying is limited and varied across international jurisdictions. Although expert advice from clinicians and scientists will be fundamental to agreeing a list of approved substances for this purpose, in any area of medicine it would be challenging to achieve consensus on the medicines or substances to be used. The amendment may therefore open up the regulation-making process to legal challenge on the basis that there is not unanimity, and that might extend the implementation process. In addition, there may be variations in product availability and in clinical practice among countries, and that may require different substances or combinations of substances to be used.
Secondly, the amendment would narrow the scope of the duty, focusing on the drug’s efficacy in eliminating pain as a priority impact over other factors that may be considered. Our assessment is that the experience of pain is subjective. The amendment may limit the ability of a doctor to make an appropriate clinical decision on which approved substances to prescribe for their patient. The decision on an appropriate approved substance would be a clinical decision between the doctor and the person seeking assisted dying, having regard to the needs of the relevant person, including that person’s experience of pain.
Kim Leadbeater
My view is that this is very clearly a matter for the Secretary of State, but with expert clinical and medical guidance. These are the people who should be making the decisions about such drugs. The evidence about this type of medication exists. As part of the commencement period and the consultation period, I anticipate there will be wide consultation about the drugs that are available. I think it is best left with the Secretary of State, so I would leave the clause unamended.
Danny Kruger
I will press amendments 465 to 467, but not amendment 409. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
The Chair
Before we continue, let me make a point about the process for tonight. We are not far off a vote in the main Chamber: it may happen in the next half-hour. There may be four or five votes, including a potential Division on Third Reading of the Children’s Wellbeing and Schools Bill. No doubt people will need a comfort break, so my intention is that when the Division bell rings, we will suspend for an hour and 15 minutes. I am not saying that that will absolutely the right period, but it is as good as we can judge at this stage.
Amendment proposed: 465, in clause 20, page 13, line 36, at end insert—
“(1A) A drug may only be approved under this Act if it has been approved by the Medicines and Healthcare products Regulatory Agency for that purpose.”—(Danny Kruger.)
Question put, That the amendment be made.
Kim Leadbeater
I beg to move amendment 379, in clause 21, page 14, line 10, at end insert—
“(3A) The coordinating doctor must, as soon as practicable, give a copy of the final statement to the Commissioner.”
This amendment requires the coordinating doctor to give the Commissioner a copy of a final statement.
The Chair
With this it will be convenient to discuss the following:
Amendment 500, in clause 21, page 14, line 10, at end insert—
“(3A) Regulations under subsection (3)(a) must provide that a final statement contains the following information—
(a) the person’s full name and last permanent address;
(b) the person’s NHS number;
(c) the name and address of the person’s GP practice (at the time of death);
(d) the coordinating doctor’s full name and work address;
(e) the date of each of the following—
(i) the first declaration;
(ii) the report about the first assessment of the person;
(iii) the report about the second assessment of the person;
(iv) the certificate of eligibility;
(v) the second declaration;
(vi) the statement under section 13(5);
(f) details of the illness or disease which caused the person to be terminally ill (within the meaning of this Act);
(g) the approved substance provided;
(h) the date and time of death;
(i) the time between use of the approved substance and death.”
This amendment provides that regulations about the form of a final statement must make the provision mentioned in paragraphs (a) to (i).
Amendment 439, in clause 21, page 14, line 20, at end insert—
“(7) The relevant body must supply—
(a) full medical records,
(b) court records, and
(c) all documentation relating to the assessments and procedures,
relating to bringing about the death of the person in accordance with this act must be made available to the Chief Medical Officer and the Assisted Dying Commissioner.
(8) For the purposes of subsection 7 the ‘relevant body’ is—
(a) the coordinating doctor, if they are a practitioner with the person’s GP Practice;
(b) in any other case, the person’s GP practice.”
This amendment would require full medical records, court records and all documentation relating to assessments and procedures to be supplied to the Chief Medical Office and Assisted Dying Commissioner.
Clause stand part.
Kim Leadbeater
Amendment 379 would ensure that the co-ordinating doctor provides the commissioner with a copy of their final statement in cases in which the person has successfully been provided with assistance to end their life in accordance with the Bill. That is an important part of the reporting procedures and of the role of the commissioner. If agreed to, the amendment will ensure a robust recording and monitoring process for assisted dying.
Amendment 500 provides that regulations about the form of the final statement must make the provision mentioned in paragraphs (a) to (i) of proposed new subsection (3A). It builds on my amendment 214, which would amend subsection (3)(a) to require that the form of the final statement must be set out in
“regulations made by the Secretary of State”.
This is another way of ensuring robust and thorough reporting.
Danny Kruger
I thank the hon. Lady for explaining the purpose of the amendments. Amendment 500 specifies the information that a final statement must contain. Will she clarify why there is no requirement to record any details of what happened once the drugs were administered, other than the time between the use of the approved substance and death?
In this debate, we have acknowledged the importance of record keeping. If the intention is to maintain public confidence in the system, should there not be some provision to record whether complications happen and what complications there were? This skirting of the issue of complications is concerning. We have ruled out explicitly informing patients of the risk of complications.
Kim Leadbeater
I do not think that anyone has ruled out discussing complications. Clause 9 makes it clear that the doctor has a very clear discussion with the patient about what will happen if they proceed with an assisted death.
Danny Kruger
I am sorry; I mis-spoke. I should have said that we have ruled out clarifying the expectations of what doctors should do in the event of an assisted death, and whether or not that is specified by the patient.
Earlier today, the Committee again ruled out specifying what the obligations on doctors are if complications arise, whatever the patient has discussed earlier. With this amendment, we now seem to be ruling out gathering any information about what happened, which is surely vital not just for safeguarding but to develop good practice in the operation of the Bill, a point that the hon. Member for Ashford made earlier. There is too much silence in the Bill, between the taking of the substance and death, on what happens if there are complications, what is permitted and, now, what is recorded. Amendment 439, in the name of the hon. Member for York Central, attempts to address that point. I hope that the Committee will accept it.
Naz Shah
I rise to speak to amendment 439, tabled by my hon. Friend the Member for York Central, which would amend clause 21 such that the relevant body would provide the chief medical officer and the commissioner with the full set of documents relating to a person who had undergone assisted dying. The relevant body would be the co-ordinating doctor if that person were a practitioner with the person’s GP practice. If the co-ordinating doctor did not meet that condition, the person’s GP practice would have the responsibility of sending those documents.
Those documents would be the person’s full medical records, court records and all documentation relating to assessments and procedures relating to the person’s assisted death. I note that “court record” refers to the Bill before we agreed to the amendments and new clauses that replace the High Court procedure with a panel system. We should be able to slightly tweak the wording to reflect that when we tidy up the Bill. That is what the amendment does. Let me say a little about why it does so and how it would make the Bill stronger.
The key aim is to ensure proper public oversight of any assisted dying scheme. The Bill creates the role of the voluntary assisted dying commissioner, who will look at and report on the workings of the system, appoint panel members and be the final court of appeal, so to speak. Those are far too many powers to give to one person, but if we are giving the commissioner a duty to report on how the system works, they should have the best possible information. It is only right that the information also be sent to the chief medical officer for England or for Wales, as appropriate; they are both very senior public officials and experienced doctors.
My hon. Friend the Member for Spen Valley has tabled amendment 382, which, to quote the explanatory statement,
“provides for monitoring, investigation and reporting functions under Clause 34 to be carried out by the Voluntary Assisted Dying Commissioner (instead of the Chief Medical Officers for England and for Wales).”
I will have more to say on that amendment when we come to it, but removing the chief medical officer from the monitoring, investigation and reporting functions is not a good idea.
What use could the commissioner and the chief medical officers make of the data provided under amendment 439? Let me give some practical examples. If there were reported instances of a person experiencing discomfort or pain as a result of taking the medication, that would be of interest to the CMO and the assisted dying commissioner. It could trigger a further exploration of the titration of medication used in the procedure. As another example, let us think about what could happen if a family raised concerns about a person receiving assisted dying despite lacking capacity or being coerced. The CMO and assisted dying commissioner could use the information provided to investigate those allegations.
The amendment will ensure that the assisted dying commissioner and the chief medical officer receive detailed qualitative as well as quantitative data on people who have received assisted deaths. It is an important step towards making sure that the assisted dying scheme receives proper, well-informed scrutiny. In turn, that scrutiny will make it less likely that the scheme will allow abuses or ignore serious problems. I urge hon. Members to support the amendment.
Rebecca Paul
I will be very brief. I rise to ask a few questions about clause 21 as a whole. Following our debates on various amendments, I am aware that family and those close to the patient could not be involved in the process, although potentially for understandable reasons. I appreciate that we are not here to deal with the whole operational piece, but we should think about it. For example, what happens with notifying next of kin after death, bearing in mind that “next of kin” has a different meaning after death? That is when we start to get into legal considerations, such as who the executor is—and this could be the first time that they are hearing about it. What would be the process for that, given that the person has potentially died on their own at home with the doctor?
What is the process for handling the next stage? Is there anything that we need to include in the Bill to make it a clearer, simpler and easier process? Who will the medical certificate of cause of death be given to for registration of the death? While all that is going on, what will happen to the body? At that point, we may not have family members to take care of that. Those are some questions arising from clause 21 that are worth reflecting on.
Stephen Kinnock
The amendments relate to clause 21, which applies where the person has been provided with assistance to end their own life in accordance with the Bill and has died as a result. Throughout this process, we have worked with my hon. Friend the Member for Spen Valley. Amendments 379 and 500 have been mutually agreed on by her and the Government, so I will offer a few technical and factual comments.
Amendment 379 would require that, where a person has been provided with assistance to end their life and has died as a result, the co-ordinating doctor must provide the voluntary assisted dying commissioner with a copy of the final statement under clause 21 as soon as practicable. That links to the commissioner’s role in monitoring the operation of the Bill, as set out in new clause 14. Amendment 500 sets out the information that must be included in the form of a final statement, which is to be set out in regulations in accordance with amendment 214.
The effect of amendment 439 would be to introduce a new requirement for the relevant body, defined as either the co-ordinating doctor or the person’s GP practice, to provide full medical records, court records and all documentation related to assessments and procedures relating to bringing about the death of the person in accordance with the Bill to the chief medical officer and the voluntary assisted dying commissioner. The amendment is broad, and it is not clear whether doctors would be able to comply with the duties fully.
For example, GPs do not normally have access to court records, and would need to request them to provide them to the chief medical officer and the commissioner. Currently, a decision to share court records is made at the discretion of the judiciary in most cases. As such, any statutory burden to disclose court records agreed by both Houses would require consultation with the independent judiciary. Depending on the type of record, there could also be data protection considerations.
Kim Leadbeater
I have nothing to add other than to respond to the fair point made by the hon. Member for East Wiltshire about complications. The doctor does have to record the final statement in the medical records, and I am confident that they would also record any complications in the medical records. Similarly, we have talked about the code of practice with regard to complications, so there is scope to include what would happen in those instances there. It is, however, a fair point, and it could be something to look at amending on Report, if the hon. Gentleman wants it to be in the Bill.
Amendment 379 agreed to.
Amendment made: 500, in clause 21, page 14, line 10, at end insert—
“(3A) Regulations under subsection (3)(a) must provide that a final statement contains the following information—
(a) the person’s full name and last permanent address;
(b) the person’s NHS number;
(c) the name and address of the person’s GP practice (at the time of death);
(d) the coordinating doctor’s full name and work address;
(e) the date of each of the following—
(i) the first declaration;
(ii) the report about the first assessment of the person;
(iii) the report about the second assessment of the person;
(iv) the certificate of eligibility;
(v) the second declaration;
(vi) the statement under section 13(5);
(f) details of the illness or disease which caused the person to be terminally ill (within the meaning of this Act);
(g) the approved substance provided;
(h) the date and time of death;
(i) the time between use of the approved substance and death.”—(Kim Leadbeater.)
This amendment provides that regulations about the form of a final statement must make the provision mentioned in paragraphs (a) to (i).
Clause 21, as amended, ordered to stand part of the Bill.
Clause 22
Other matters to be recorded in medical records
Kim Leadbeater
I beg to move amendment 380, in clause 22, page 14, line 25, at end insert—
“(1A) The coordinating doctor must, as soon as practicable, notify the Commissioner that this has happened.”
This amendment requires the coordinating doctor to notify the Commissioner of a matter mentioned in subsection (1).
The Chair
With this it will be convenient to discuss the following:
Amendment 440, in clause 22, page 14, line 34, at end insert—
“(4) For the purposes of subsections (2) and (3)(b), the information recorded must include—
(a) any interventions made by a medical practitioner in response to the procedure failing, and
(b) the timing of those interventions.”
This amendment would specify certain information to be recorded under section 22 when the procedure fails.
Clause stand part.
Kim Leadbeater
The amendment would require that if a person has decided not to take the substance or the procedure has failed, the co-ordinating doctor must, as soon as is practicable, notify the commissioner of that. It is fairly straightforward.
Sean Woodcock
I rise to speak to amendment 440, which stands in the name of my hon. Friend the Member for York Central. It concerns what the doctor must do when they are supervising an assisted dying procedure. It would add a requirement for the medical records to include
“(a) any interventions made by a medical practitioner in response to the procedure failing, and
(b) the timing of those interventions.”
Should the procedure fail and the person start to suffer complications, record keeping will be vital. That is particularly true because the Bill does not provide clear guidance on what doctors should do if a person starts to suffer complications during the assisted dying process; it states that a doctor and the applicant should discuss before the procedure what the applicant’s wishes would be if they suffer complications. We have heard from the Minister that doctors should use their clinical judgment when that happens to a person undergoing assisted dying. Some doctors may commence lifesaving treatment; others may decide to wait and watch while the patient suffers complications in the hope that those complications do not last too long.
Collecting accurate records will enable the authorities, including the Secretary of State for Health and Social Care, to compile information on people suffering complications during assisted dying procedures, however few they are. That in turn would allow for several things. It might allow doctors to compile data on which drug combinations and methods are most likely to bring about complications. It could help doctors and medical authorities to write procedures for responding to patients who suffer such complications. That information could also be used to inform patients about the likelihood of suffering complications if they go ahead with assisted dying.
We have heard from several hon. Members that good record taking is essential to monitoring and safeguarding assisted dying. Unfortunately, in other jurisdictions there are significant gaps in the data on when patients have suffered complications. In Oregon, records are destroyed the year after each annual report, and physicians are not required to be present when lethal drugs are taken, so the reports of complications depend on information provided by whoever was present at the time. Complications are recorded via a form, but in 2023, 72% of complications in cases were listed as unknown.
Simply recording the fact of a procedure failing will not provide enough information for monitoring, review and improvement. We should aim to do considerably better in the data we collect on patients who suffer complications, and that is why I urge Members to support the amendment.
Danny Kruger
I rise to speak to amendment 440, which stands in the name of the hon. Member for York Central. I echo the points made by the hon. Member for Banbury. Surely it is the case that the interventions made by a medical practitioner in response to the procedure failing, and the timing of those interventions, must be properly recorded. Should the procedure fail, the need for record keeping is of significant importance, as with all medical record keeping.
The doctor with the patient should write up the notes, including the times at which they reacted negatively to the procedure, the amount of medication that they consumed, any side effects and any action taken. That is good practice. In other jurisdictions there has been poor record keeping, as I mentioned, when things have not gone according to plan. We do not fully understand what happened in those instances or, more generally, the prevalence of complications in those jurisdictions. That information will be vital if further interventions are required, including emergency care.
Clause 22 deals with two situations: if the person decides not to take the substance or if the procedure fails—the phrase “Other matters to be recorded in medical records” seems a rather innocuous title for a clause that deals with such situations. In fact, I think that is the only mention of the procedure failing in the whole Bill. However, the clause, and amendment 380, simply require the co-ordinating doctor to notify the commissioner that it has happened as soon as practicable. Do we have any sense of when the doctor should judge the procedure to have failed? I would be grateful if the Minister or the promoter could offer a definition of procedural failure. What does that actually mean?
That question arises in other jurisdictions that have assisted dying laws. A 2019 paper by the Canadian Association of MAiD Assessors and Providers said:
“There is no clear cut-off for what constitutes ‘delayed time to death’ or ‘failed oral MAID’.”
At what point does a delayed time to death yield to failure? That question is not just abstract for us; it is a philosophical question in other contexts, but we are required to answer it. That paper goes on to suggest that
“clinicians should decide with patients in advance at what point they will consider inserting an IV and completing the provision”,
which is a rather euphemistic term but we know what it means. That is legal in Canada, but it would not be here, so what happens?
In written evidence, Dr Alexandra Mullock, who is a senior lecturer in medical law and co-director of the Centre for Social Ethics and Policy at the University of Manchester, pointed out:
“The Bill is silent on the precise obligations of the doctor if the procedure fails.”
Clause 18(9)(a)(ii) states that the doctor must remain with the person, but what the doctor should be permitted to do, either in relation to aiding recovery or supporting the person to die after the initial attempt has failed, is unclear. She said:
“During my work with the Nuffield Citizen’s Jury, the issue of what happens if the drugs do not end the person’s life was raised within the evidence presented to the jury, and this became a point of concern for several jurors.”
She also said:
“By not addressing this question within the Bill, it allows doctors to exercise clinical discretion, however, it is arguably legally and ethically preferable to clarify the position and address public concern by including a clause that covers this problem.”
I hope that is helpful.
I will end by referencing the hon. Member for York Central, who tabled amendment 440 and made the case very powerfully. She said that should the procedure fail, the need for record keeping is of significant importance, as with all medical record keeping. I have already said that, but we cannot have too much of the hon. Member for York Central.
Stephen Kinnock
Amendment 380 is one that the Government have worked on with my hon. Friend the Member for Spen Valley. As the Bill currently stands, clause 22 sets out that where a person decides not to take an approved substance provided under clause 18 or where the procedure fails, the co-ordinating doctor must record that that has happened in the person’s medical record or inform a registered medical practitioner with the person’s GP practice. The amendment would require that in those circumstances, the voluntary assisted dying commissioner must also be notified.
I turn to amendment 440. As I have just mentioned, clause 22 provides that the co-ordinating doctor is required either to record in the person’s medical records or inform a medical practitioner registered at that person’s GP practice if the person has decided not to take the substance or the procedure has failed.
The amendment increases the requirements on the co-ordinating doctor to document in such cases any interventions made by a medical practitioner and the timing of those interventions. The requirement on the co-ordinating doctor to record interventions following a failed procedure is open-ended in time, which could lead to operational challenges. For example, the co-ordinating doctor would remain obliged to record the medical interventions made by others in response to the procedure failing, even if those interventions took place weeks or months after the event itself. I hope that those observations have been helpful to the Committee.
Kim Leadbeater
I have nothing to add, other than to say that the complications that have been referred to many times today would be covered by the code of practice that we will introduce by agreeing to amendment 430.
Amendment 380 agreed to.
Amendment proposed: 440, in clause 22, page 14, line 34, at end insert—
“(4) For the purposes of subsections (2) and (3)(b), the information recorded must include—
(a) any interventions made by a medical practitioner in response to the procedure failing, and
(b) the timing of those interventions.” —(Sean Woodcock.)
This amendment would specify certain information to be recorded under section 22 when the procedure fails.
Question put, That the amendment be made.